Posted by mtdewcmu on April 2, 2011, at 17:31:57
In reply to Re: Opiates and tolerance--could suboxone be worse? » mtdewcmu, posted by psychobot5000 on April 2, 2011, at 16:50:11
> > > Question: is it possible buprenorphine/suboxone is MORE likely to produce tolerance and a negative rebound in mood than other opiates?
> > >
> > > The reason I ask is that it clearly does, for me, while I have never observed this effect with other opioid medications. Suboxone, which I understand has a roughly thirty hour half-life, typically improves my mood for the first part (say, six or eight hours) of the first day, before leveling off. By the second day after a single dose of .5mg (particularly the second half of the second day), when the blood levels are presumably dropping, my mood is lower than it would otherwise be. Third day can be bad, too, but by the fourth things are more or less back to normal. Moral of the story: for me, taking suboxone comes back to bite me in the face.
> > >
> > > However, I've never noticed such an opioid-induced depression when taking, say, regular pain pills. Is it possible the very high-occupancy of receptors of suboxone makes its rebound effects on mood MORE pronounced than traditional opioids? Seems counterintuitive, but I thought I'd ask. I'd like to know whether it's a safe bet that I should stay away from regular opioids--which would be too bad. Sometimes they seem helpful for mood and cognition, without any observed negative effects on mood, though I've only ever used them sparingly and in limited quantities.
> > >
> > > Thanks,
> > > Psychbot
> >
> > Most pills have a half-life of about 4 hours. The longer you're on opioids, the worse the eventual withdrawal will be. There are a number of variables in play, but the simplest explanation is that buprenorphine just lasts longer.
>
> I did think of that, naturally. Occam's razor, it's probably right. Nevertheless, I wonder whether an alternate explanation is possible. I've been on pain pills for a few days after surgery, and don't remember any lowness in my mood afterward.
>
>When you initially take opioids, it takes a long time to get withdrawal. You become sensitized to withdrawal up to a point as you take more and more opioids. So you may get more withdrawal from the same amount of opioids now than you did then.
Hydrocodone feels more intoxicating than buprenorphine, so you may have taken a much stronger dose of bupe (in terms of mu activation) even though it didn't feel stronger.
The steadier blood levels of bupe may lead to more withdrawal over time than the spikier blood levels you get from repeatedly taking vicodin (if you integrate the area under the curve). Plus, your blood level of vicodin would drop a lot while you sleep, whereas with bupe, you are still racking up withdrawal.
There could be some pharmacological difference in withdrawal liability between the chemicals, but these three principles explain a lot.
poster:mtdewcmu
thread:981738
URL: http://www.dr-bob.org/babble/20110321/msgs/981757.html