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I am addicted to oxycodone hcl and was put on subutex from…

Customer Question
Hello, I am addicted...

Hello, I am addicted to oxycodone hcl and was put on subutex from my doctor. I’ve heard from some people that subutex does not put you into precipitated withdrawals because it does not have nalaxone in it, is this true? My last dose was about 8 hours ago and I’m starting to feel weird. Can I take subutex?

Doctor's Assistant: What are all the symptoms you're experiencing (e.g. loss of appetite, fever, rash)?

Stomach cramping, muscle aches, starting to sweat a little, and pressure in my head.

Doctor's Assistant: Is the headache episodic or daily? And what about nausea?

Well this is the first day I haven’t taken my oxy in a while but I usually never get headaches.

Submitted: 1 month ago.Category: Medical
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Answered in 32 minutes by:
12/28/2017
Doctor: Dr. D. Love, Doctor replied 1 month ago
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,243
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hello from JustAnswer. This is Dr. Love.

No, it is not true, but not for the reason that you state. The people that have given you this information do not understand the buprenorphine or the naloxone.

Let's deal with the naloxone first. As long as the drugs are taken as directed, the presence or absence of naloxone does not alter whether withdrawal occurs. The naloxone in Suboxone is not really absorbed, and what is absorbed is metabolized in the liver, so does not get into the general blood stream. The only reason that naloxone is present in Suboxone is because of concern that people might crush Suboxone and inject the medicine. If the patient were to do so, the naloxone would block any opiate in your system and precipitate withdrawal. But as long as the Suboxone is taken correctly, the buprenorphine will be absorbed and the naloxone will not. The doctor will decide whether there is a concern that any specific patient may inject the drug, and if the doctor is concerned, then the doctor will prescribe Suboxone rather than Subutex.

The reason that Suboxone and Subutex can precipitate withdrawal is because of the buprenorphine. The buprenorphine will partly stimulate the opiate receptor and partly block the opiate receptor. There are several characteristics of buprenorphine that derive from this mixed effect.

First, there is a ceiling effect from buprenorphine, also called a plateau. With most opiates, as you take larger doses, you get a greater effect, but with buprenorphine, the increased effect with an increased dose is only true for mild to moderate doses, and higher doses will not have any greater effect. As higher doses of buprenorphine are used, the blocking effect is stronger, including blocking additional stimulation of the opiate receptor by the buprenorphine.

Second, the buprenorphine can induce withdrawal if there is a significant amount of other opiates in your system. If someone with no opiates in their system takes buprenorphine, the predominant effect is the stimulation of the opiate receptor, up to the ceiling effect. But if someone already has a significant amount of opiate in the system, the blocking effect is more predominant, and this is manifested as induced withdrawal.

So, when someone is started on any formulation of buprenorphine, it is better to wait until it is certain that any other opiates in the system has essentially left the body. Small amounts are not so much of an issue, but if you are still getting significant opiate effect, then taking buprenorphine will induce some withdrawal. Within that context, yes, you can take Subutex, but it is better to only take the Subutex when the oxycodone is out of your system, or at least mostly out of your system.

If I can provide any clarification, please let me know.

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Doctor: Dr. D. Love, Doctor replied 1 month ago

Is there any further information that would be helpful?

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