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Contents 1 Buprenorphine page should be separate from Suboxone page 2 Suboxone Withdrawal 3 Subutex vs. Suboxone 4 something's wacky here, needs to be fixed 5 Inpatient rehabilitation section?! 6 Commercial preparations 7 Edit for Suboxone page 8 Suboxone Flavor 9 Updated Suboxone information under "preparations" - and comment about subsequent section lengths 10 Parochial USA content makes this article confusing. 11 Lots and lots of changes made 12 Major changes needed 13 "Withdrawal Danger ?" 14 suboxone and use during pregnancy 15 Recreational use 16 Buprenorphine vs. Methadone 17 Street Reports

Buprenorphine page should be separate from Suboxone page

I know that things like hydrocodone and vicodin are not generally given separate pages, being that they differ in one active ingredient. But they both server the same purpose - pain relief.

In the case of Suboxone, its use is different than the use of either of its components alone. It is used for opioid addiction treatment, not pain relief. I think separate articles would go a long way in making this information more accessible. Especially given the general dislike the 12-step proponents seem to have of this drug, and lack of neutrality the article tends to display. (on and off as differing camps edit the article back and forth.)

66.41.0.174 (talk) 20:38, 28 November 2007 (UTC)

                    QUESTION=HOW LONG IS BUPRENORPHINE IN YOUR SYSTEM?  —Preceding unsigned comment added by 71.234.226.18 (talk) 05:18, 27 January 2008 (UTC) 

Suboxone does not need a seperate article. Subutex, Suboxone, Temgesic and any other brand seeking to use Buprenorphine as its active ingredient seeks right to be listed under this article. This article focuses on Buprenorphine which entails any drug using Buprenorphine as an ingredient, now and in the future. There are 100's of different morphine preparations, it would be stupid to open an article for each one. However, I do agree this article needs pay less emphasis on the different brands such as Subutex and Subuxone. --78.86.159.199 (talk) 18:14, 16 August 2008 (UTC)

Suboxone Withdrawal

After reading the article, I thought it would be helpful if there were more information about withdrawal from Suboxone. There is currecntly a lot of discussion by users in various online communities regarding the claims that withdrawal from Suboxone is milder as reported by both the manufacturer and literature (that is, milder than the opioid one was dependent on before Suboxone treatment. While withdrawal symptoms are subjective, some users' experiences of Suboxone withdrawal are not consistent with the word "milder" and it would be nice to see some new research here or at least a mention of the problem. —The preceding unsigned comment was added by 72.200.68.198 (talk) 09:52, 18 March 2007 (UTC).

Subutex vs. Suboxone

The manufacturer recommends starting with Subutex because it does not have the Naloxone component. Naloxone has side effects which could be severe enough to encourage the patient to stop taking the medication completely. Naloxone is not needed unless the patient has a propensity to inject drugs. Unfortunately, some doctors are adamant about using Suboxone. If that is the case with the patient, find a doctor that doesn't insist on Suboxone but will use Subutex instead. Even better, when the patient calls to make his first appointment, ask the nurse at the office if Subutex is prescribed. If the nurse says no, then hang up and call another doctor. Do not take more medication than you need to detox.

Also, try and move consistently down off of Sub as quickly as possible. Listen to your body. If you have been addicted for several years, it may take a longer time than if the addiction is shorter in time. It's possible to detox in a month but the patient must be highly motivated and follow a strict plan.

Some patients remain at the highest levels for extended periods of time. That is not necessary and should be avoided.

One example of a taper schedule is:

Starting at 12mg, then: 10mg-2 weeks 8mg- 3 weeks 6mg- 3 weeks 4mg- 4 weeks 3mg- 4 weeks 2mg- 4 weeks 1mg- 4 weeks .5mg-4 weeks .5mg every other day 6 weeks

Total- 35 weeks

However, keep in mind that the taper schedule will be different for everyone.

Lastly, it's often difficult to determine what the equivalence of Sub vs. the drug of choice of the patient. One tool can be found at: http://www.medcalc.com/narcotics.html. This is a good tool but it is certainly not a perfect tool. Even doctors have a hard time making this determination. For example, 10 tablets of Vicodin is about 100 mg. of hydrocodone. That translates to about 8 mgs. of Sub. Even though Sub. has a long half-life, it's also a good idea to split the Sub. dose so that the active chemical stays relatively stable throughout the day. Anyone contemplating using this med to escape narcotics, feel free to contact my Talk Page for additional help. Jtpaladin 16:34, 11 April 2007 (UTC)

OK just one comment for anyone who reads the otherwise ox comment above. Ten tablets of Vicodin would not be 100 mg of hydrocodone. It would be 50 mg. If it was Vicodin ES it would be 75 miligrams of hydrdrocodone. 10 tablets for 100 mg would be Vicodin HP (which is pretty uncommon) or another formulation of Hydrocodone/APAP.

something's wacky here, needs to be fixed

from the "dependence treatment" section:

"In the United States, a special federal waiver is required to prescribe Subutex and Suboxone for opioid addiction treatment on an outpatient basis. However, if the doctor meets none of the other clarifications, an 8-hour course is all that is required)."

"clarifications?" huh?

This is poorly stated - Subutex and Suboxone are both ONLY prescribed for opioid addiction, for which a dr. must have a DATA2000 waiver this would also allow them to prescribe methadone. However, unlike methadone, an additional 8-hour course is required before being approved to prescribe Suboxone/Subutex.

TIP-40 is a publication detailing Suboxone/Subutex use, clinical guidelines, and legal specifics. A copy should be linked to. I'll see about adding that.

This is actually incorrect. As a patient of back surgery I have been put on Subutex for back pain. It works incredibly well. Aftre being on the pure agonists I find Subutex to be an excellent pain killer. My pain mgmt. doctor uses his regular DEA # to prescribe this for me. He said that his DEA # begins with a Z, may be an X but i think a Z, when he prescribes for opiate dependency. He uses his normal DEA # for regular pain mgmt. when scripting for subutex. —Preceding unsigned comment added by 68.84.119.213 (talk) 18:16, 15 May 2008 (UTC) 66.41.0.174 (talk) 20:30, 28 November 2007 (UTC)

Inpatient rehabilitation section?!

Is it just me that's deeply uncomfortable with this section in particular? A huge amount of unreferenced stuff, and frankly I've got no idea where some of it's come from or why it's in an article on subutex / suboxone / buprenorphine.

Feels to me like this could do with a lot of work, some decent and brutal editing, and a fair few more references. If there's anything I can add / reference then I'll have a peek later (particularly around detox treatments / pro-social networks in recovery) but tbh I feel there's a whole lot of stuff in here that's on the wrong page and is - frankly - largely irrelevant with a somewhat ideological hue.

A couple of the other sections strike me as a wee bit flabby / unreferenced n all, but hey. I'll have another look later, and if I can't suggest anything more constructive or make any positive additions / contributions I'll butt out completely, ha.

81.2.126.58 09:24, 13 June 2007 (UTC)Geoff

This information contained about the induction dosing is particularly necessary to an article on buprenorphine as it has a very unique initial dosing phase. The section could definitely stand to be re-written; however, I do not see most of it as irrelevant.

Perhaps if Wikipedia had an entry on "Opioid Treatment Programs" then the rest of the information contained in this section outside of the induction dosing in an inpatient setting could simply be linked to? But there is no such article.

Lucida.ann 21:14, 27 August 2007 (UTC)

Commercial preparations

It says no human studies have been done on the effectiveness of intravenous buprenorphine/naloxone preparations but in the manufacturer's prescribing information it talks about studies done with IM injections of buprenorphine/naloxone? I'll double check the insert, but I'm pretty sure it's all there.

Effect of Naloxone: "...whereas administered intramuscarlarly, combinations of buprenorphine with naloxone produced opioid antagonist actions similar to naloxone."

to print these results in an insert they would have to have observed these effects in humans, correct? Azrayl 02:09, 18 September 2007 (UTC)

I'm not sure I understand. Intravenous is not the same as intramuscular. --Galaxiaad 03:15, 18 September 2007 (UTC)

Oh I am sorry, I was reading intravenous as intramuscular, so the article is correct that there has not been (official) human studies observing intravenous bupe/naloxone preparations. Azrayl 17:25, 18 September 2007 (UTC)

Edit for Suboxone page

I just wanted to let you guys know that Suboxone isnt intended to have an orange flavor. In the actual drug form from R-B its listed as having a lemon-lime flavor. If anyone wants a picture from the brochure for proof let me know. kylewmackey@gmail.com —Preceding unsigned comment added by 67.189.252.63 (talk) 01:15, 2 October 2007 (UTC)

Being someone who takes this medication, I can say that until someone told me it was supposed to be lemon lime, I would have said it tasted like orange tang. The color of the tablet probably is enough to suggest that any citrus flavor be interpreted as orange. 66.41.0.174 (talk) 20:32, 28 November 2007 (UTC)

Suboxone Flavor

clip::

SUBOXONE is an uncoated hexagonal orange tablet intended for sublingual administration. It is available in two dosage strengths, 2mg buprenorphine with 0.5mg naloxone, and 8mg buprenorphine with 2mg naloxone free bases. Each tablet also contains lactose, mannitol, cornstarch, povidone K30, citric acid, sodium citrate, FD&C Yellow No.6 color, magnesium stearate, and the tablets also contain Acesulfame K sweetener and a lemon / lime flavor.

From
http://www.rxlist.com/cgi/generic/suboxone.htm67.189.252.63 18:06, 2 October 2007 (UTC)Kyle Mackey

it's the most god awful lemon lime i've ever tasted. the taste of it makes me want to puke more than the opiate content. 65.210.123.70 (talk) 21:08, 6 June 2008 (UTC)

Updated Suboxone information under "preparations" - and comment about subsequent section lengths

11 December 2007 - London

Hello

I have added the most relevant studies around Suboxone's effects in human subjects when it is injected, as well as the best available evidence about Suboxone's potential for abuse/black market in the community (Finland only!).

In my view the following sections around buprenorphine-based detox are way too long. It would be better for Wikipedia if we instead cited external sources or guidelines around detox - these do after all vary substantially by country, as do the methods of proving opioid dependence treatment using buprenorphine-based products.

Cheers

193.130.97.35 (talk) 10:38, 11 December 2007 (UTC)

Parochial USA content makes this article confusing.

It would be useful for the reader (myself included) to seperate out the parochial USA content from the main theory and research. The USA specific information interupts the article and considerably lengthens passages. more consise information would be helpful with perhaps seperate sections for USA issues which are only specific to 1% of the global population. It would be great if someone with appropriate detailed knowledge could attempt to edit accordingly! HDTomlinson (talk) 03:38, 7 January 2008 (UTC)H.D.Tomlinson (UK)

Lots and lots of changes made

Hello everyone....

Came across this page tonight and found it riddled with errors of all sorts, including that NA hadn't made a statement regarding maintenance therapy and that buprenorphine is PREFERABLE over methadone during pregnancy!!! (Which I'm going to guess anyone reading this knows is totally not true.)

I added and changed A LOT, and I will be adding in the remaining associated links, etc., for the information I changed/added.

--Lisamarie (talk) 07:35, 26 January 2008 (UTC)

Major changes needed

Hey Wikipedians. I just marked this article as {{cleanup-rewrite}} because, frankly, the quality of the article is terrible. This should probably be a task for WikiProject Pharmacology to take on with full force and extreme prejudice. Random bold and strike-out? Sentence fragments and run-ons? This is not how Wikipedia operates. I urge anyone who can work on this to do so, even if you can improve only one section. --Animated Cascade ^talk 06:20, 5 April 2008 (UTC)

"Withdrawal Danger ?"

To me this sounds like cases where doctors have overprescribed buprenorphine, and some one is taking upwards of 16mg a day, which is insane. I went from a huge heroin habit, to several hundred milligrams of oxycodone, and started on 4mg of subutex a day. Very few doctors even remotely understand this drug, yet somehow went through all the work to become licensed to prescribe it.

After Working with lots of folks who have taken or are still taking buprenorphine, and being an addict myself who takes buprenorphine. "extreme acute withdrawal" is not something I have EVER witnessed or felt-first hand with buprenorphine. www.heroin-detox.com is not a reference/citation. Unless there is a real source for this date, this should be removed. Azrayl (talk) 18:13, 1 July 2008 (UTC)

I think you make a great point, my hat goes off to you. I am both an addict and a professional in the field. Like you, although I have never had a huge habit of over seven bags (shity Miami dope before the Columbians came in the mid 90s), I have seen plenty of addicts both active (I tried doing an underground needless exchange while I was on methonde) and in recovery. I think there is a huge amount of data missing regarding buprenorphine.

I have "heard"(pretty reliable source,someone like me :), but not me) of one case of an extremely bad and long withdrawal from an IM bupernorphine (not Suboxen)addiction. I understood the guy got it from Spain a few decades ago. He was, intermuscular shoot huge (way over 16mg in the 100s) amount of bupernorphine per day and the doctor in USA who apparently knew very little about buprenorphine at that time attempted to withdraw the guy quicker than "prescribed". The same source told me that eventually this gentleman tried to IV the buprenorphine and suffere a stroke (I do not know if this is rare or a comman situation... I understand this gentleman still around but not doing well. But from what I understood from my source is that his withdrawl at that time was very bad.

Again, my hat goes off to you, for requesting and demanding data. I do not know whether we should be requesting that information should be removed... I suggest that a note should be placed, at the source and the location of your complain indicating your givance and to see the discussion. That way we should indicate the need for data and demand for research in that category. As "addicts" and consumers of this services, we should be "demanding"<for a lack of a better word" more relevant data and creationg of best practice protocols. Whose treatment is it any way? Good point yours.

Stroke caused by IV is pretty common amongst many IV users of all types of drugs. It's generally due to improper injection, needles, adulterants and other factors which in turn form a clot leading to stroke. Buprenorphine does not cause a stroke is used properly. --78.86.159.199 (talk) 00:04, 1 September 2008 (UTC)

suboxone and use during pregnancy

Suboxone is a pregnancy category C₁. Which means it should only be used with EXTREME caution during pregnancy.₂Basically this means that only if the benefits outweigh the risks on the mother and fetus. Suboxone use during pregnancy may cause the newborn to undergo withdrawal symptoms immediately after birth. The child may have to be weened off of the medication to prevent severe DT's and other side effects that come with the withdrawal symptoms. This may take weeks or months to completely rehabilitate the child.

references: 1. www.suboxone.com 2.clinical pharmacology edition 8 pg 7 dislpay 1.3 Lpn2008 (talk) —Preceding comment was added at 20:43, 16 July 2008 (UTC)

Recreational use

Buprenorphine is a popular recreational drug (typically used by opioid users) in Sweden. I would add something about this, but I'm having a hard time finding sources and articles that are not in swedish. 【 Mqa^Talk 】 15:24, 5 August 2008 (UTC)

That goes with any opiates. One study I recently came across showed there are half as many regular opiate users in the world as there are alcohol users. --78.86.159.199 (talk) 18:22, 16 August 2008 (UTC)

Actually, buprenorphine (typically in the form of subutex and suboxone) is very popular among opioid users in Sweden (and other scandinavian countries) - much more so than in other countries - which is why I think it would be interesting to write something about it. I will look for some research on this. 【 Mqa^Talk 】 16:08, 22 August 2008 (UTC)

May I suggest you use an electronic translators like Google and translate those articles in Swedish and then write your article. What you think? —Preceding unsigned comment added by 67.191.51.101 (talk) 15:14, 26 August 2008 (UTC)

That sounds lika a good idea, but the cited source will still have to be in swedish, and therefore hard to verify. I'll try to find something in swedish, and we'll see what I can do about it.【 Mqa^Talk 】 09:46, 27 August 2008 (UTC)

I added some information about buprenorphine abuse in Finland and Sweden.【 Mqa^Talk 】 10:56, 27 August 2008 (UTC)

Comparing the popularity of Buprenorphine over other opioids is the same as saying Vodka is more popular amongst the Russians than other alcoholic drins. Is it worth mentioning buprenorphine is used more recreationally than other opioids in Sweden? --78.86.159.199 (talk) 00:12, 1 September 2008 (UTC)

Buprenorphine vs. Methadone

Please reduce the Buprenorphine vs. Methadone section. There is too much cross analysis and too little conclusiveness for it to be granted a paragraph under an article such as this. Either move the Buprenorphine vs. Methadone section into its own article, the article regarding opiate addiction or be prepared to leave a less analytical conclusion. --78.86.159.199 (talk) 18:22, 16 August 2008 (UTC)

With all due respect, I think the issue of Bupernorphine vs Methadone probably needs more information than it is given here. Heroin users do have a chice now on two different medications with different characteristics, assests and limitations. This is a extremly large issue for opiate users when it comes to treatment. At least it will required a special link or attention from this article. I personally do not have any problems with extensive cross analysis without conclutions. In some sciences when not enought research is available what we end up with is a lot of data and not enough conclutions until we beging to make some sense of the data.(Carlos.Franco) —Preceding unsigned comment added by 67.191.51.101 (talk) 15:22, 26 August 2008 (UTC)

You are forgetting, an encyclopedic article is not an study, essay or a place to keep comparing, analyzing different aspects of an issue or for first hand analysis. The Buprenorphine and Methadone section concludes little, but rather keeps cross comparing different issues in a rather essay styled and guide like writing. It needs cutting down heavily, with the raw facts, cited findings and conclusions only. If that writing was in the context of an study, essay, or a manual it would be totally fine, but not for an encyclopedia. It needs filtering. Also, don't forget, this is an article on Buprenorphine, not addiction or the best treatment for addiction. Mentioning that Buprenorphine, although an opioid painkiller is also used for the treatment of addictions and the reasons why it is and why it may be preferred over methadone is enough. Details on the best treatment (whether its buprenorphine, methadone, or other) for opioid addiction's are a topic of its own and have no place here. Perhaps you should open an article or add it to the article regarding opioid dependency treaments. Also remember, Wikipedia her is not a place to discuss the quality, validity of studies carried out, Wikipedia as with any other encyclopedia, needs to only mention the facts and significant findings associated with medically accepted studies, leaving any opinion based information in regards to any findings at the hand of the user. The section also drifts of to areas tottaly irrelevant to this article, such as the UK opiate prescription likelihoods, or details on detox programmes. Although I am a professional in the medical field, and most of the claimed points are arguably true, the writer, out of approximately 30 points made, only cites 5 of them with a valid source which is against Wikipedia guidelines. The section needs to be condensed with only relative information directly associated with Buprenorphine and its use for opioid addiction remaining written in a factual conclusive manner with valid sources to back the statemetns made. Rephrasings such as "in other words" or magazine/manual style explanations need to replaced with a more factual to the point phrases. Almost 1/3 of the information in the Dependence treatment section are irrelevant to the drug it self, Buprenorphine, and can find a better home in articles such as Opioid dependency, Drug addiction (treatment section) which need attention themselves. However, I personally feel the treatment of opioid addiction itself deserves a separate article, which a filtered version of the aforementioned section can find a good home.--78.86.159.199 (talk) 00:18, 1 September 2008 (UTC)

Street Reports

I've got a street report that the president was kidnapped by aliens. Should we include that in Wikipedia too? Please remove this. Not only is it completely without source, a "street report" wouldn't be a reliable source anyways. Thanks.12.207.120.160 (talk) 09:50, 18 August 2008 (UTC)

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