Suboxone For Cocaine Addiction???????

[Narkotikon]

I had dinner with my sister tonight. The one I was severely pissed off at a week or two ago. Anyway, she has let this guy move in with her under several conditions: he gets a job, doesn't use coke (although he's been drinking and doing his Xanax she said--I personally don't see how that's staying sober, but anyway), that he help pay rent, utilities, etc. Apparently she let him move in 25 days ago, and she said he's still detoxing. I said from what? She said coke. I said X, coke is mainly a psychological w/d. I'm sure he doesn't feel good, but you wouldn't still be detoxing 25 days later. I said are you sure it's not the Xanax or alcohol, and she said no, because he still takes that. I think she's either misinterpreting detox for just anxiety / craving that lasts for along time after you quit coke, sort of like PAWS I guess. Or, that she's right and he's lying and really used more recently than 25 days ago.

Anyway, that's not the point. The point is that she called her doctor to see what she would suggest for coke detox, and apparently the doctor told my sister about Suboxone being used for coke addicts. I was like, huh? I've read I think about bupe being used for alcohol dependency / addiction, and I've read about Revia (naltrexone) being used in the treatment of alcoholics. I don't think I've ever read anything about any opiate being used for coke addicts though. I know that coke affects dopamine, and so do opiates in correlation to endorphins, but I still think it's different. I mean, a coke high isn't like an opiate high, at least to me. It's different. They both may affect dopamine, but I think it's through different means. I told my sister that that didn't seem right to me, because I can see how Subs would help any addict because it would just get you high if you're not an opiate addict. I mean, say a coke addict took a normal or a little above normal dose of bupe, it would get them high. It doesn't get me high because I'm an opiate addict, but it would him because he's not addicted to opiates. So, yeah, anytime you get someone high it's going to make things better.

Anyway, I was just surprised at that, and wondered if anyone else had heard of bupe / Subs being used for cocaine addiction? I personally don't think it would help. I think it would cause them to be either dependent on opiate or even addicted to them, and then they'd just have another drug addiction. If they do use Subs in cocaine addiction, is it at the regular dose that an opiate addict would take? I mean, it couldn't be. 8mg or even 2mg would be too much for an opiate naive person. If they use bupe, it can't be Subs. Is it Buprenex or Temgesic? I've just never heard of this. I know that Suboxone / Subutex is only approved for the management of opiate dependence. Does anyone know if it's also used for cocaine addiction and if so why? I can't understand how this would be a good thing if it's true. Could someone explain?

Edit: I'm really just wanting to know if Subs are really used for coke addicts, and if so, why. The stuff about my sister was just backstory leading up to that.

[runormal]

when i got started on subs my doctor did say that subs have been shown to reduce cocaine cravings .... he didn't explain why or how, i was just very surprised. i didn't get any benefit in that regard - i actually went on 3 month coke binge and then it was wellbutrin that has cured my cravings for coke 100% which is great. about a week after i started the wellbutrin i woke up and instead off calling my dude to get going for the day i was just over it. the strangestthing thats happened to me all year, i thought for sure i wasn't going to be able to stop and then pow! no more thinking about it even.
but yeah the dr did say the subs help the coke cravings. it might have just been a sell - it was our first meeting - but after working with him this long he doesn't seem the type to bullshit.

[Narkotikon]

Thanks. I appreciate it. It doesn't make much sense to me. Maybe someone can explain the science behind it. I'm inclined to think it is just another ploy to make more money off of Sub patients. But, information and answers is what I need. Anyone know?

[Duckfeet]

I'm always interested in this shit, or in european treatments of hepatitis C, and even think there are sides to methadone and subs, not really investigated yet, since there is no money in studying drugs available generically, which is why most serious studies of *generic* drugs are European...I've been curious about why my glucose--I'm non-insulin dependent diabetic--has gone so high since I got off methadone...I exercise, eat right (kind of)...and keep hoping it'll drop back down...and I'd rather be on insulin, if I have to...than go back to the constipation and lethargy I suffered w/on methadone...

But as far as subs go, I agree that there does need to be much more studies done, as there is just too much that has been happening to people on subs, and doctors don't seem to have a *clue* on how much to provide, and also, I too have heard people say that if it *does* work on opiates, that it seems to also work on other drugs, so there must be something to this....and I'm also curious as to *why* it doesn't work on heroin addicts like myself, as I *really* wanted subs to work, and paid beau coup money to find out that, for me, they didn't...

[resorcinol]

I do think that a mu opioid full or partial agonist would reduce cocaine cravings, bupe included. It's one hell of a trade off though, since you're willfully accepting physical dependence instead of mostly psychic dependence.

But I can totally see opioids reducing coke cravings. Opioids stimulate the release of dopamine in the nucleus accumbens by inhibiting the firing of GABA(B) neurons in the VTA area of the brain, which usually acts as a brake on dopamine release in the NAc. This is why opioids are SO MUCH more euphoic than other downers.

[Badly Drawn Girl]

I know that there has been some research along those lines. I found a couple of articles for you. I think for the most part that people with a dual addiction are getting some relief from both while taking Bup. But I haven't heard of people being prescribed it if they have NO previous issues with opiates. That seems to be trading in one addiction for a new one, at least in my mind. I know there are some new drugs on the market (or possibly old drugs for off the label use) that are being used to treat cocaine addiction. I cannot remember the name off hand though.

I will say that methadone stopped my coke use and I certainly wasn't expecting that. Especially since I was combining coke with methadone for recreational use. So I can see Bup have a similar affect.




Buprenorphine May Help Cocaine Users Too

http://alcoholism.about.com/cs/coke/a/blnida040319.htm

Qualitative findings showed that, for participants who received 16 mg of buprenorphine daily, the number who tested positive for cocaine fell by nearly 53 percent and the number who tested positive for heroin fell by almost 43 percent by the end of the study. For those who received 8 mg of buprenorphine daily, the number who tested positive for cocaine fell by nearly 22 percent and the number who tested positive for heroin fell by almost 30 percent.

Buprenorphine suppresses cocaine self-administration by rhesus monkeys

http://www.sciencemag.org/cgi/content/abstract/245/4920/859?ck=nck

Daily administration of buprenorphine (an opioid mixed agonist-antagonist) significantly suppressed cocaine self-administration by rhesus monkeys for 30 consecutive days. These data suggest that buprenorphine would be a useful pharmacotherapy for treatment of cocaine abuse.

[simfromstoke]

i know a lot of doctors and studies have been done with prescribing SUBUTEX for coke addicts in england. i cant remember off-hand, all the details but i'll ask in rehab on friday as they are quite clue'd up in there and im sure they'll be able to answer a few questions on the subject

and another drug that i take is also used for SOME coke addicts and its been proved to HELP is Baclofen.
im prescribed it for spinal spasms - i slipped a disk 12 years ago and when i get really cold my body starts to shiver quite badly and the spasms have pulled muscles in my back recently
my doc prescribed Baclofen (which is for MS sufferers primerily) to relax my back muscles, but its been proven to reduce the cravings with coke addicts for some reason...

-sim

[Narkotikon]

Thanks for the replies. I sort of see it the way Resorcinol sees it though: you're trading a coke addiction for an opiate addiction when you're done. Plus, what dosage would the coke addicts take? Why couldn't take 2mg or 8mg or more because they'd get horribly sick from being non-tolerant to opiates. This just really surprised me.

[bigNasty]

I know there are some new drugs on the market (or possibly old drugs for off the label use) that are being used to treat cocaine addiction. I cannot remember the name off hand though.



You might be thinking of Prometa treatment which is a benzo antagonist(can't remember the name), hydroxyzine, and gabapentin. I don't see how that could help treat alcoholism and cocaine addiction. The benzo antagonist seems like it would make a heavy alcoholic feel alot worse or even cause DT's since they NEED benzo's the first few days to avoid serious physical WD's

[jonny-5]

i think the reasoning behind it is that its a whole new market of people to come and pay the doctor hundreds of dollars a month. i think its really just as simple as that.

[The_Highwayman]

I know there are some studies being done on suboxone/buprenorphine used for refractorty unipolar depression and has worked well, that is how I started using buprenex to combat my lifelong crippling depression, and it works wonders now for it....I could see them using the bope tp help getthrough the cocaine or simply the malise that got them using cocaine to begin with....

[Badly Drawn Girl]

You might be thinking of Prometa treatment which is a benzo antagonist

That's it! Thanks Big, I couldn't remember the name and I'm actually interested in doing some more research on it. It was being used as a form of treatment for addicts that were incarcerated in my state but they ended the program. The father of my kids has been addicted to cocaine for almost 20 years and I'm certainly interested in anything which might help him. He's been through more rehab programs than I can honestly remember.

[orjunkie]

I am a Board Certified Psychiatrist and have been treating opiate addicts with Suboxone for a few years, at the 100-patient limit for the last couple years. I have a PhD in Neurochemistry. I am also a recovering opiate addict—I used to be an anesthesiologist. There is no reason that buprenorphine, the active ingredient in Suboxone, should reduce cocaine cravings. I have not heard of any studies showing effects on cocaine cravings or use in England or anywhere else. I just did a literature search on Ovid at the medical school where I teach, and found no studies of buprenorphine and cocaine use. I doubt it exists, but if there is a reference to such a study please send it to me through my blog, SuboxoneTalkZone. I treat a number of cocaine addicts and the lack of effective treatments for cravings is quite frustrating.

The brain is way too complicated to predict effects on cocaine cravings based on the release of dopamine. Many things cause dopamine release in the brain’s reward centers; exercise, smoking, alcohol, sex… but none of those will reduce cocaine cravings!

On the other hand, it is logical to expect a reduction in alcohol cravings from Suboxone. We have known for years that the mu opiate antagonist naltrexone reduces alcohol cravings; in fact, naltrexone is indicated for that that treatment by the FDA (and NOT indicated for opiate dependence!). Since buprenorphine has potent antagonist effects at the mu receptor, effects on alcohol cravings would be expected—and are what I observe in many patients who have addictions to both opiates and alcohol.

Finally, baclofen is a GABA agonist that has shown very preliminary effects on cocaine cravings in animal studies—and is far from ‘proven’ as an effective medication for that purpose. Many other medications have shown similar promise over the years, only to be shown useless in larger, controlled studies.
Even if we did find an agent to reduce cocaine cravings, like buprenorphine it would likely need to be taken by the addict indefinitely. Addiction doesn’t go away. The features of neural tissue that make addiction permanent are the same features that allow memories to form; a person doesn’t get over addiction any more than a person can ‘forget’ how to ride a bicycle!

[Duckfeet]

I remember you: glad to see you posting again...:)

Why do you think there is such inconsistency among doctors on how *much* buprenorphene to prescribe?...we pretty much have to figure out ourselves how much is *reasonable* and there are too many credible stories about people getting at higher doses--docs are o.k. with this--and having serious physical and mental problems(which mimics withdrawal symptoms)...NAABT.org tells us which docs can prescribe it...and I found that my doc knew very little about subs...


I am a Board Certified Psychiatrist

<snip>

a person doesn’t get over addiction any more than a person can ‘forget’ how to ride a bicycle!

[Indy]

There is no reason that buprenorphine, the active ingredient in Suboxone, should reduce opiate cravings.


I really hope you meant to say cocaine cravings...................

[Duckfeet]

I thought that at first, Indy, that it was an error...then I remember my *own* experience w/bupe...and it *didn't* reduce the opiate cravings: it just got rid of withdrawal symptoms...u know, all the physical shit, and mental depression...but one of the reasons bupe does *not* work so good for heroin addicts and such, is that it doesn't seem to get rid of cravings for us...but I figured same as u, that he meant coke...but again, for me, and many others, it did *not* reduce cravings, but just made it useless to do dope, since it had such powerful opiate antagonist...weird....


There is no reason that buprenorphine, the active ingredient in Suboxone, should reduce opiate cravings.


I really hope you meant to say cocaine cravings...................

[orjunkie]

Duckfeet, I'm not sure what you are referring to-- tell me about a 'serious European study of generic drugs'. The only thing I can imagine you are referring to would be the herbal products that are more frequently used in many European countries-- not because of 'greater study' though-- more because if their lack of an equivalent agency to our FDA that demands that claims of medical efficacy by backed by genuine science!


As for Suboxone, we 'know' the proper doses to use. Buprenorphine is not new-- it has been around for a couple decades, and the use for opiate addiction is 10 years old! After treating a couple hundred opiate addicts, I find that the reason Suboxone sometimes fails is more a function of a patient who is not ready to stop using than a problem with buprenorphine.


I got clean from opiates the 'old fashioned way' (drug of choice IV fentanyl-- as an anesthesiologist my supply was endless, as well as plenty of morphine, demerol, dilaudid, sufedntanil (10 times more potent than fentanyl)... no 'medicated withdrawal', no Suboxone-- just stop using and be as sick as death for a few weeks-- followed by about a thousand NA meetings over 15 years. If a person is truly 'sick and tired' of using, it works-- if you work it. Suboxone will make it much, much easier to stay clean, but the primary issue still holds-- the addict has to truly want to stop using. And that takes getting the stuffing beat out of you a few times. And some addicts have more stuffing than others. To be frank, an addict who blames the failures of a drug for his own inability to stay clean isn't ready to stay clean. In my experience as a doc, and as a fellow addict, the addicts who eventually stay clean are the ones who don't blame anthing or anybody-- but themselves!

[Narkotikon]

I feel an argument coming on.

[orjunkie]

Sorry Duckfeet for the hostile-sounding message. I am typing fast because I want to go to bed-- but I find this darn interesting conversation....

I am a nicer person in the morning. I'll stop back and apologize tomorrow.

JJ

Or to lick my wounds...

[Duckfeet]

No apology necessary...

The European studies I was referring to, go back to my days as listowner on the only HepC mailing list--pre web days--and we were desperately trying to find studies of options other than interferon...I'm not going to spend hrs on google looking for old german studes of aspirin and what-have-you...I do not think the FDA is as respected a "scientific" source as you do...you can tell by my sigs lately than I'm a Thomas Szasz fan, and have libertarian profound beliefs about how intrenched our worship has become of the medical field...I'm sure you are aware of his views...and know the arguments against....me too...

On Bupe I stand my ground...either just about every person put on bupe is lying, or there is hardly any consistency among doctors: There are *credible* stories of the horror shows people have faced at higher doses of buprenorphene, and I can point you to permanent posts on other website, with plenty of research, and yeah, anecdotal experience...nice thing about google is you can find statistical research to support just about any claim...but that methodology is usually/often suspect...but he who gets the most statistics get the bragging rights, I guess....ah well,, why not, here's one, just so u know where I stand:
http://www.fee.org/Publications/the-Freeman/article.asp?aid=2299

My own: I went to meditox, paid five thousand bucks, and did everything they said, and got down to 1mg--just like they said--and got sick as a dog by day three...and I was in AA, seven years sober, had a hang-gliding accident, conked on head, dilaudids while "out of it" and then strung out and wanting off *highly* motivated....there are countless similar experiences...The second time, I went to NAABT.org, and did their doc-finder, and got a local doc--from Africa--who's wife also did some kind new age shit out of same office, and he obviously was kind of clueless, but I knew enough to be in wdrawals before I got on subutex, and he went along with whatever I wanted, and was happy enough to put me on 16mg daily...by then, I myself knew enough to get on down to 4mg, but opiate cravings never went away....back on methadone: the devil I know....

And since at the end you threw a bit of the what I consider the stock treatment center msg: the addict has to want to stop using...well, they always "want to stop using..." Until they don't again...everybody quits until they quit quitting...

I've got to say I don't agree with that either...subs have weird shit, and I've seen too many people get their hopes up, get told all kinds of stuff by their bupe-docs, and then fail and fail again: and it's a nice way of blaming the addict by saying: "well, they just aren't ready to quit..."

And NA--or my own AA--seems to have very little studies (how could they: nobody can even agree on how to *count* sobriety...or "cleantime" to use an NA term)...on our own efficacy...by *medicalizing* our problem, and giving control to the FDA or our drugs, we have all became like little babies in the governmental daycare center....we have just ceded our rights to our own bodies...as long as drugs are illegal, and my constitutional right to my own property--my body--is denied me, how will we ever know..."disease"...right...

And since we are forgiving our hostilities here, u might as well forgive mine, since--no offense--but every bupe doc I've met, or heard about...was there due to failure in other fields, or not "making it" in America...never seems to be "first choice..." I'm not buying any of it:

I trust the experiences of my fellow addicts, as--just like w/methadone--most truths don't come out right away, and we had to bank on street knowledge since docs were notoriously unreliable...vocabulary and degrees are handy when making a point...but I've learned to be *very* distrustful of people "in the field..."

Welcome back to Opy...I *knew* I remembered you...;)

Sorry Duckfeet for the hostile-sounding message. I am typing fast because I want to go to bed-- but I find this darn interesting conversation....
<snip snip>

As for Suboxone, we 'know' the proper doses to use. Buprenorphine is not new-- it has been around for a couple decades, and the use for opiate addiction is 10 years old! After treating a couple hundred opiate addicts, I find that the reason Suboxone sometimes fails is more a function of a patient who is not ready to stop using than a problem with buprenorphine.



I got clean from opiates the 'old fashioned way' (drug of choice IV fentanyl-- as an anesthesiologist my supply was endless, as well as plenty of morphine, demerol, dilaudid, sufedntanil (10 times more potent than fentanyl)... no 'medicated withdrawal', no Suboxone-- just stop using and be as sick as death for a few weeks-- followed by about a thousand NA meetings over 15 years. If a person is truly 'sick and tired' of using, it works-- if you work it. Suboxone will make it much, much easier to stay clean, but the primary issue still holds-- the addict has to truly want to stop using. And that takes getting the stuffing beat out of you a few times. And some addicts have more stuffing than others. To be frank, an addict who blames the failures of a drug for his own inability to stay clean isn't ready to stay clean. In my experience as a doc, and as a fellow addict, the addicts who eventually stay clean are the ones who don't blame anthing or anybody-- but themselves!I am a nicer person in the morning. I'll stop back and apologize tomorrow.

JJ

[jonny-5]

for me personally, bupe does *reduce* opiate cravings, but by no means does it come close to eliminating them. but when i compare my life completely off opiates to my life just on bupe, i cant deny that it does reduce my cravings. but i can only speak for myself.

[Narkotikon]

I like bupe. It doesn't get me high, but then again it's not supposed to. I mean, I do get a sort of uplifting feeling for the first few weeks, but after that it just fades. Personally, and this is just based on my own theories, I think it depends on your tolerance. Bupe is only a partial agonist. If you're a die-hard heroin addicting shooting two bundles of dope a day, then no, bupe probably isn't your cup of tea. I think methadone would be a better option for that person. For me though, whose tolerance isn't that high, it's perfect.

I sort of think of it this way. Bupe is for pill popping housewives, methadone is for the hard-core addict.

I think bupe does supress cravings, but it depends on what kind of tolerance you have. Obviously if you have a higher tolerance, you're going to need more bupe. But, the thing with bupe is that you can only take so much before it starts to act more like an antagonist than an agonist, and if you've ever taken to much you know that it fucks with you. That's why they say less is more, and it goes against all junky-thinking: more "usually" is better. With bupe it's not. So, for those with higher tolerances, I think it's probably not going to work so well. But it does work for some. I mean, it's not a useless drug created by the pharm companies to make money. Well, it's overpriced, so in that respect it is, but it does work for some.

I also don't buy the "it's the addict's fault it doesn't work." Methadone did NOT work for me. Sure, I wasn't craving and wasn't using, but at what cost? I was eating two half-gallons of chocolate chip ice cream a day and drooling on myself in front of the TV. I was too medicated and too sedated, and told that the higher I went the better it would be. And since I had never done methadone before, I believed the clinic. Again, more is always better. Not true sometimes. It wasn't anymore my fault I was over-medicated, than it is someone's fault who doesn't do well on bupe. Sometimes it just doesn't work for everyone. All I know is that it works well for me.

For me, personally, I did best on 8mg of Sub a day. I would either take it once SubL like I was supposed to, or I would snort 2mg q.i.d. I can get by on 2mg though, because that's the lowest I got down to when I was getting off of it. I wasn't happy, but it wasn't bad. I still don't know how people can get by on less than 2mg. I mean, I believe them and all, but I can't do that. But, again, I can't see how people would need 32mg either. I'm sure there are some, but I just assume their habits are a lot worse than mine. 8mg, for me, was perfect.

[The_Highwayman]

Orjunkie, I always wanted to be an MD, and if my music doesn;t work out I will try to get my PhD is psychology...

As a psychiatrist, what are your feeling or what have to seen in research for buprenorphine used for treating depression, even with people who have no opiate problems. I got into IM then IV buprenex becasue I have been battling depression for over 10 years and no drug helped so I self-medicated with buprenex and tried in vain to get my docotr to prescribe me it, unfortuatley it got costly and not as effective so I moved up to heroin and now am back on subs..but I would love to hear your views....