Does Buprenorphine Really ‘Save Lives’?

Legal disclaimer: Nothing in this post is meant to be construed as medical advice. I am not a physician or pharmacist. Discuss any medications, changes, or questions you might have with your medical provider. Do not suddenly stop any medication unless under the direct guidance of a medical provider.

Today was a weird day. What began with some light historic-ecclesiastical reading and plans to write a piece about a specific trend in feminism in antique literature, turned instead into a Twitter brawl in which I repeatedly questioned doctors and pharmacists on a certain status quo, and received 5th-grade-style memes of Homer Simpson in response. What was the cause? Buprenorphine.

More popularly known as Suboxone or Subutex, buprenorphine (“bupe” for short) has been touted in recent years as “the” drug of choice to treat opioid dependence disorders (formerly known plainly as “addiction,” for politically-incorrect and insensitive jerks like me, or so I was told).

Although my concerns about the safety and efficacy of buprenorphine became quickly misinterpreted as a war on drug addicts (or whatever the PC term is now), I ended up spending the day reading through study after study (see below for a list), but was hopelessly ganged up on by dozens of angry and less-than compassionate “professionals” who took the time to point out I must know nothing about the subject because I also “make jewelry.”

They insisted I could not read scientific or medical literature although such things are written in English and I am blessed to have access to ‘foreign’ objects like the internet and dictionaries to look up any unfamiliar terms, and in short, I had it all wrong, and my misinformation would inevitably lead to the untimely end of numerous, unnamed individuals. I just needed “to trust my doctors,” insisted one.

They had already read all the studies and charts I supplied, which is why they needn’t bother to look at the ones I provided and actually answer my questions. I hadn’t been privy to that much gas-lighting since the most recent family holiday.

I guess I touched a nerve.


What is Buprenorphine?

Buprenorphine is most commonly used in the US to treat opioid addiction. The idea is to transition people off heroin (and dirty needles, and other unhealthy practices associated with street drug addiction) and/or illicit painkillers. In much, much smaller doses (micrograms vs. milligrams), it is used to treat severe pain. Bupe is an opioid, and can cause addiction in and of itself.

all opioids are addictive

-Source*


Is Buprenorphine Safe?

This is the question that most concerns me, and I have legitimate reasons to wonder:

Although more people have access to bupe than ever before, OD rates are still rapidly climbing. Dr. Andrew Kolodny insists this is because “more people need more access to bupenorphine,” but haven’t we seen this doubling down of ineffectual policies before? Yes, except 5 years ago, the trend began with the false narrative that irresponsible doctors were getting people hooked on opioids. And who started that claim? Oh, yeah, that Dr. Kolodny guy.

drug overdoes chart for Mont. Co

My interview with a local substance abuse counselor from 5 years ago, indicated bupe was neither as safe nor as effective as touted. She told me then “substance abuse counselors hate it.”


Money, Money by the Pound!

There have been many back-end, sly marketing techniques, going on for at least a decade by the makers of bupe, Reckitt-Benckiser/Indivior, recently accused of attempting to artificially prolong the patent on Suboxone.

There is a ton of money to be made by doctors who prescribe it (average $300 for first appointments, $150 or more for subsequent/monthly appointments, and whatever can be earned in lab and pharmaceutical kickbacks).

Federal guidelines were recently widely expanded to allow those doctors to be able to treat hundreds of patients at one time, instead of the strictly limited 30 patients from 12+ years ago (the strict limit was put in place to prevent doctors from essentially dealing the drugs to patients.

Now that it has been eased, a number of questionable practices have been increasing). A push by none other than PROP board members, via an article in the New England Journal of Medicine, asserts than everyone from nurse practitioners to OB/GYNs can and should be able to dispense buprenorphine, not just addiction specialists.

Bupe, in the form of Suboxone, costs an average of $151-518 for just 30 days of sublingual filmstrips for the uninsured, depending on dosage, and about $180-720 for 30 days of sublingual tablets, depending on dosage, up to 3x/day, although an original study of the drug, paid for in part by Reckitt-Benckiser, show the drug can last up to 3 days before needing a new dose. This was, in fact, a huge selling point of bupe, that people would not need to come daily to Suboxone clinics for the medication.

Patients on bupe can successfully go for 2-3 days on just one dose, reducing the need for daily clinic visits, and/or “reducing the need for take-home medications [which] decreases the possibility of illicit diversion and abuse of opioid dependence pharmacotherapies (Section 6)”


No Such Thing as Chronic Pain?

Contrary to PROP’s claim they do not want to ban opioids (of course they don’t, buprenorphrine is an opioid) or that they want to stop “drug companies” from promoting long-term opioids for chronic, non-cancer pain, Dr. Kolodny, founder and director of PROP, frequently promotes his ideas that essentially, there is no such thing as chronic pain, just opioid addiction.

That being the case, both birds can be killed with one stone groups can be helped via long-term maintenance with the opioid buprenorphine (made by a “drug company”).

only addicts, says kolodny


There is an enormous body of evidence dating back literally millennia that points to the existence of chronic pain as a real and devastating illness if left untreated.

Copies of medical texts from Ancient Egypt and Greece to modern times describe hundreds at least, of debilitatingly painful conditions with no cure from back injuries to rheumatoid arthritis and damaged nerves, that impact the lives of an estimated 50 million chronic pain patients in the United States alone.

It is, at minimum, grossly irresponsible to claim these people and their well-documented diseases and the expertise of thousands of doctors don’t exist!

There is a form of bupe called the “Butrans patch,” made for chronic pain (the chronic pain that “doesn’t exist”). Many insurance companies are forcing patients and/or their doctors to try it or the fentanyl patch, although there are also extended-release (ER) pill formulas for Vicodin/norco at far lesser dosages that suffice most chronic pain patients just fine. Ironically, many of these companies have new “addiction reduction” policies that refuse to take chronic pain patients and their medical histories into account.

So why are these insurance companies pushing so hard for medications that are far stronger than what doctors want patients on? I called one popular insurance company, Anthem/Blue Cross-Blue Shield, who told me the Butrans patch was “not any stronger,” than other ER medications, contrary to what my own doctor and these charts show.

According to Drugs.com, the Butrans patch for chronic pain is known to actually cause pain and severe illness, withdrawal syndrome, and a host of psychological effects associated with drug abuse including anxiety and depression, agitation, hostility, and paranoia. It is not safe around children, pets, pregnant or nursing mothers, and must be dispensed in micrograms not milligrams like most pain medications.

butrans patch dosing


That Old-Time Naloxone is Good Enough for Me

In an odd twist, Dr. Kolodny and his group, PROP, also push for buprenorphine to replace other long-acting, lower-strength opioid medications, insisting the abuse potential is much lower because of the Naloxone (Narcan) element in Suboxone.

However, “The Clinical Pharmacology of Buprenorphine: Extrapolating from the Laboratory to the Clinic,” by Sharon L. Walsh and Thomas Eissenberg, received on Dec. 19, 2002, and published by Elsevier and Drug and Alcohol Dependence on Feb. 4, 2003, and funded in part by Reckitt-Benckiser, the very makers of Suboxone, Subutex, and other very popular forms of buprenorphine, to introduce buprenorphine to clinicians, describing its safety and efficacy findings and how it appears to work, reveals:

“The doses of naloxone that precipitated withdrawal [in patients given 8mg of sublingual and 3 and 10mg doses of BPN/day]…were approx. 10 times greater than those that precipitated withdrawal in patients maintained with 30mg oral methadone” (Section 3.2.3).

Most patients are maintained on far higher doses, and the study’s authors also found other studies reported no withdrawal effects in patients given 8mg/day of bupe and challenged with 4mg of naloxone. The amount of naloxone in 8mg of Suboxone preparations is only 2mg.


The One “Good” Opioid in the Epidemic?

Current stats show the increasing rates of bupe abuse, and the original studies of bupe emphasize it, “does posses abuse potential.” Furthermore, the study describes bupe as producing “paradoxical” effects, “the same dose of buprenorphine can produce no detectable effects or it can produce prototypic opioid agonist effects and intoxication” (Section 3.2, emphasis added by blog author).

“Buprenorphine is not being monitored systematically enough to gauge the full scope of its misuse, some experts say. The Centers for Disease Control and Prevention does not track buprenorphine deaths, most medical examiners do not routinely test for it, and neither do most emergency rooms, prisons, jails and drug courts (emphasis added).

“I’ve been studying the emergence of potential drug problems in this country for over 30 years,” said Eric Wish, the director of the Center for Substance Abuse Research at the University of Maryland. “This is the first drug that nobody seems to want to know about as a potential problem.” –Source


Why Aren’t People Getting Clean with Bupe?

The study’s authors’ appeared to assume that patients on bupe could and would be easily transitioned (weaned) off with minimal withdrawal side effects. A relatively fast period of only 5 days claimed patients went from 8mg to 1mg with no withdrawal signs observed or symptoms reported (Section 3.2.3), but more and more patients are being maintained on moderate doses of 8-20mg of bupe indefinitely.

The study even states that patients on bupe can successfully go for 2-3 days on just one dose, reducing the need for daily clinic visits, and/or “reducing the need for take-home medications decreases the possibility of illicit diversion and abuse of opioid dependence pharmacotherapies” (Section 6, emphasis added by Rambling Soapbox).

suboxone od and abuse-is it safe-Source

Buprenorphine is an unusual drug by all accounts, which has been the cause of much misinformation, however it works just like any other opioid. According to multiple studies, it causes the exact same effects as other opioids, including intoxication, sedation, euphoria, respiratory depression, constipation, behavioral impairment, and urinary retention.

suxone od rises

Source

What sets bupe apart, is how it binds with opiate receptors in the brain. Many people think it blocks the effects of other opioids, but bupe binds faster and longer than more traditional opioids, including heroin and OxyContin.

According to Emergency Medical News, bupe, methadone, fentanyl, and often even oxycodone CANNOT BE DETECTED IN URINARY ANALYSES, and while chronic pain patients have been legally limited, force-tapered, dropped from practices, abused, forced to endure routine UAs although physically disabled, and stigmatized to taking 90MME (morphine milligram equivalence) or less (or none) for their safety, addicts are recommended to take many times that amount!

how much bupe vs pain pills

 


99 Problems, and the Studies are 1, 2, 3…

Concerning trends arise upon review of certain buprenorphine-related clinical studies, including the Walsh and Eissenberg study. Extremely small numbers of subjects were tested, for example, 7, 5, 10, 8, and 8, throughout the 1990s (Walsh and Eissenberg, Section 3.2.1). Other “larger” studies had only 99 subjects.

More recent studies include odd comparisons of numbers that effectually obscure real conclusions like this one from Spain, which looked at 19 other studies published between 1974-2016 (an odd range with no explanation given) from several high-income countries, more than 70% of whom were males with mean ages of 23-39.6, and featuring around 100K patients in 13 different groups on methadone for 1-13 years, but only around 15K patients in 3 groups on buprenorphine for just 1-4 years, to show how patients remained alive while on MAT treatment.

The doctors I “spoke” with on Twitter claimed that patients were more likely to die once off bupe, citing studies in European countries like this one, but a quick review reveals the key seemed to be patients who were both on a medication-assisted treatment (MAT) like bupe AND in a supervised, residential treatment center. Much like the ones the substance abuse counselor I interviewed 5 years ago lamented the loss of…


This is Not Treatment

Unlike the assumptions in the original study that patients on bupe will either receive treatment in-office, or be prescribed a single dose to last up to 3 days, there has been a strong push to allow addicts to be prescribed bupe for take-home use, such as this message, brought to you by the curious National Alliance of Advocates for Buprenorphine Treatment.

In other words, people with addiction issues to narcotics are being given powerful narcotic prescriptions a month at a time to take home, a scenario the study’s authors never imagined or recommended!

take bupe home with you

Let me restate: people with self-control issues around opioids are sent home with bottles of opioids and expected not to overdose? No wonder the relapse rate is so high. That is devastating.

recidvism rate for OD

Stats prove that drug abusers often mix different classes of drugs (known as a “cocktail) resulting in overdoses, so why should buprenorphine be pushed as the only cure-all when, not only are there two more established addiction treatment drugs, namely Methadone and Naltroxene (Naltroxone, in particular, is a non-opioid that also works to reduce cravings for alcoholism), but Narcan and bupe will not work to reduce cravings for the other types of drugs many users abuse, including antidepressants, anti-anxiety meds, stimulants, and hallucinogenics. This might be why:

-Source

Does Buprenorphine Really Save Lives?

“Buprenorphine is now more popular than cocaine, ecstasy, and heroin in some European countries. It is easy to obtain, currently quite fashionable, popular with opioid aficionados, and apparently associated with a quite pleasurable high when injected or snorted.

I would not be surprised to see more BPN issues in the ED, given the rise in its popularity, its increasing availability, and its perceived wide margin of safety. One might be confused by an opioid toxidrome with a negative drug screen unless the drug has been identified by history.” –Source


Sources Cited


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5 thoughts on “Does Buprenorphine Really ‘Save Lives’?

  1. I’ve been talking about the serious problems with Buprenophine for a few yesfs. It was a nurses who had worked at a state prison I’d been dating who told me how it has become popular in prisons as a standard drug panel will not detect it . Much more expensive as in $_2,000 a inmate , GC MS tests specifically run for it . Convicts quickly found out and as it is a flim it is very easily smuggled in to correctional facilities. The pills less expensive Buprenophine pills minus the next to useless Naloxone are also easily smuggled in via corrupt guards who think it’s no big deal as Buprenophine has been hyped as anti addiction drug or bizarrely a opioid blocker ! Who do you think might be behind those lies . My guess are the the Rummler Foundation and another group who is invoked with our own version of Joesf Mangle , Andrew Kolodny and his fanatical friends in PROP . Who are involved in the medically assisted addiction treatment industry . Which picked Buprenophine in particular the more expensive Suboxone over much less expensive Methadone. Which is also a effective and safe when used for brief periods . Though Methadone does not produce the high . It also has some effect on neuralgia. Oh wait we can’t have pain relife that’s addiction! (Sarcasm alert) Buprenophine also is known to inhibit the induction of anesthesia. Causing awareness die mg surgery a horrifying experience that is known to cause PTSD and obviously make a patient less willing to have surgery . Good job PROP ! Buprenophine is a schedule three drug interestingly. Addicts can get three refills before seeing the physician for a new R X .While Hydrocodone and oxycodone combination meds are now schedule 2 how convenient for those addiction treatment facilities or doctors . They can easily take in $ 500,000 or more just by prescribing one Drug . Unlike other opioid medication Buprenophine builds up a rapid dependency and the high is described as a combination of heroin and Ecstasy ! Great we are giving addicts a free high . As the latest bill to fight the opioid hysteria has funding to give addicts Buprenophine if they cannot afford it ! Why not free insulin? Free anti psychotic medication . I’m sure many with a psychotic disorder struggle to find a good paying job or some cannot work a full time job due to their disorders.Why can’t those of us who deal with PTSD after seeing combat or were injured while working in dangerous conditions get free benzodiazepines ? After all most of did not choose to be injured . The mentally ill did not choose to be mentally ill . Diabetics do not choose to be diabetics even if they acquire type 2_diabetes . Those with arthritis did not choose it and in so!e see a cannot get selfie from excruciating pain . Buprenophine does nothing and was not approved as a pain reliever as it is not as effective as morphine. It might bind much more tightly to Mu receptors . That is only one part of the medications pain reliving effects . If you want potent pain relief Fentanyl is extremely effective and safer that Buprenophine . The patch is harder to abuse and the thin matrix is al!most impossible to miscues unless you have a death wish .

    Addicts have discovered how to separate the Naloxone from Buprenophine in Suboxone . Not that it is difficult any one who can read a basic chemistry book or article on organic chemistry can do it with ite!s you can buy at ho!e depot was mart and Lowe’s ! Maybe a garden supply to get more accurate measurements .
    Buprenophine is very dangerous and difficult to taper and withdraw from . As it also binds to NMDA receptors and is highly lipophollic it is stored in fat cells which allow it to remain in the body longer. Unlike all but methadone it also has a very long halflife making withdrawal living hell . We do not know all the effects of tapering or withdrawal from Buprenophine .
    On a interesting and ironic note Buprenophine is synthesized from thebian the same alkaloid oxycodone and oxymorphone are derived from . Both are safer and more effective than Buprenophine . Opana was pulled from the market though the generic extended release versions are still available . Though it works best IV .
    Methadone was never given a fair chance and unlike Buprenophine which Reckitt Becnkiser and Indivor with help from lobbying and the fact DHHS and NIDA and a few senators and representatives had been lobbying for the lax laws to prescribe to addicts . Its disgusting really .
    If us pain patients and the so!e very brave doctors a long with others Josh Bloom at ASCH and people like myself who are either physicians , pharmacists , pharmacologists , even addiction counselors who must stay anonymous or lose our jobs . Another way PROP and Kolodny have silenced any opposition or those who can show them to be frauds and self interested liars pushing Buprenophine . They claim no financial interest or ties to Reckitt Becnkiser or Indivor A long with Amphstar which makes Naloxone and jacked the price over 3,000 percent ! The hall are involved in the addiction treatment industry that pushes MAT and I believe Buprenophine is the drug of choice at the troubled Phoenix House . Have heard they have forced it on cocaine and methamphetamine abusers . Now that makes no sense if they are supposed to be treating opioid addiction .
    I’m sure there’s is !ore just not enough time to dig . Also one needs a life beyond debunking an d exposing Kolodny and PROP a long with the CD C and others for the frauds and hypocritical sadistic evil criminals they are preying on those who cannot fight back a persistent to rehab,can’t refuse Buprenophine and pain patients and pain management doctors do not yet have a lobby group perhaps we need to h keep shoving fats and reality into the media and exposing the opioid hysteria for the fabricated crisis it is . I always ask why are addicts more important and valuable than innocent people who did all the right things and got injured orchards painful medical condition or syndrome?

    Like

  2. Great article. Thank you for writing it! I feel obligated to point out, however, that you have consistently misspelled buprenorphine (you left out the “r” after “bup”. I’d hate to see your work devalued over a simple error in spelling a made up drug name. Thanks again!

    Liked by 1 person

    1. Thank you for pointing that out! I worked all night it, and was in such a rush to get it out, I completely missed the title misspelling through my bleary eyes. 🙂

      Like

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