Dr Russ' Suboxone Protocal

Will buprenorphine show up in drug tests? Can nurses take Suboxone? Can I do drug court on methadone or buprenorphine? My PO says NO medication-assisted treatments.
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Krisopiate
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Dr Russ' Suboxone Protocal

Post by Krisopiate » Tue Jun 12, 2018 4:48 pm

Hi, I am new here, however I am not new to Suboxone or Methadone and I am currently stabilised on 80mg of methadone daily, however my plan is to return to Suboxone in the near future.

In a future thread I will talk about my experiences on both of these medications. Suboxone I was on for about 4 years. Due to some external personal stress in my life in the middle of last year, I decided to try methadone at the start of 2018 and I currently take 80mg of methadone, with no plans to go any higher in my dose, as I state in fact my plan is to return to Suboxone.

My discoveries and experiences of both medications (which I will share with you in the very near future is rather counter-intuitive) to what the experts say about both medications, except for say Dr. Junig who I am a big fan of for his studies into suboxone, he really understands these medications.

But I won't tease you too much about future revelations of both medications, in short my experiences are that Suboxone is in fact more activating than Methadone. Never underestimate just how activating Suboxone is, and be aware that suboxone is an antagonist at the Kappa receptor which is responsible for its antidepressant effects plus increased focus and concentration. Yes it is a slightly different feeling to full agonists but that is because it has these Extra effects. I also don't think Suboxone is a partial agonist, only perhaps accurately classified as a partial-agonist due to its ceiling effect and good safety profile. But on paper and in opiate comparison tables you will find that Buprenorphine is 20 to 40 times the strength of Methadone. I will talk more about my experiences soon.

Now I have placed this thread in the 'legal issues' category, if this Suboxone Protocol is not accurate and correct in reference to how Suboxone and in particular buprenorphines' efficacy and opiate effect once it reaches the stomach, then it is misleading to Suboxone stabilised patients.

But you can decide in your responses. My caveat is that my comprehension of information in general is not the greatest, so that it is possible I have not read and understood correctly.

Read below section.

*********************************

As I am planning to return to suboxone, so on an internet search today, I came across a Doctor by the name of Dr. Russ, his full name I won't disclose as I can't be 100% sure of his correct name, I understand he is a New Jersey Psychiatrist.

He states in part of his protocol the following,

Dr. Russ believes that improper technique when taking Suboxone is the main reason that many believe that Suboxone does not work effectively for opiate withdrawal. Okay so that statement is fair enough.



The most common errors people make when taking Suboxone and buprenorphine are:

1. Taking Suboxone with a contaminated tongue
Suboxone and buprenorphine are designed to be taken under the tongue (sublingually). This is a very sensitive area for absorption that is easily negatively affected by anything that produces even a thin film layer on the tongue. Therefore it is critical that the patient observe the proper technique to insure that the tongue is completely clear when the Suboxone or buprenorphine is taken. Fair enough.

2. Swallowing saliva after taking Suboxone or Buprenorphine
Buprenorphine is destroyed and inactivated when it comes into contact with the normal acids in the stomach. When taking Suboxone or buprenorphine sublingually, 80-90% of buprenorphine ends up in the saliva with only 10-20% being directly absorbed into the tongue from direct contact with the medicine film or pill.
Therefore, it is essential that people do not swallow their saliva when taking Suboxone or buprenorphine because they will be swallowing 80-90% of the buprenorphine, which is almost instantly and entirely broken down into other chemicals. These breakdown chemicals are very irritating to both the stomach and the brain, thus causing severe stomachaches and headaches in the region of the temples in about 40% of people who swallow even the slightest amount of buprenorphine.

I can agree that some people will periodically experience stomach irritation, not from inflammation caused by Suboxone, but probably just because of constipation and that our digestive systems must work harder to clear food. In fact, many studies show buprenorphine has an anti-inflammatory effect on the body. See below link.

https://www.hindawi.com/journals/mi/2017/2515408/

But to say that Buprenorphine is destroyed and inactivated when it comes into stomach. This is not my experience. Please tell me that this statement and theory is horse-shit. IE. That the amount that does not get absorbed sublingually in the mouth is then broken down in the stomach and absorbed into the blood and brain for its further Mu effects etc.

Cheers,

Kriso

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Re: Dr Russ' Suboxone Protocal

Post by suboxdoc » Wed Jun 13, 2018 11:56 am

I don't know of any studies showing more mucous on the surface of the tongue vs. elsewhere in the mouth. The oral cavity is covered by a tissue called 'mucous membrane' because it contains a high number of mucous-secreting cells. The mucous is there to lubricate the passage of food- and if you wet your finger and feel inside your mouth you'll notice that all surfaces are coated with mucous. The tongue feels rough because it is a muscle covered by papila - small bumps - that contain taste buds and other sensory receptors. EVERY surface absorbs buprenorphine. We use the sublingual area for meds because it is a handy pocket to hold thing that you don't want people to swallow.

Note that Bunavail has almost twice the absorption of sublingual Suboxone tabs or film, and that is achieved by keeping the dose against the inner cheek.

I have never had a problem with people getting enough buprenorphine. The treatment fails, though, in cases where patients have gone so far down the rabbit-hole of addiction that relieving withdrawal alone doesn't prevent using. When most opioid addiction consisted of overuse of pain pills, people came in for treatment still having jobs, still in relationships, and still having a sense of who they were. Now people come in for treatment in entirely different conditions. Getting up for work each day is a distant memory. The only relationships are with other drug users. Friends and friendly relatives are long-gone. People who have lost everything do not do as well on buprenorphine, and do not do as well in ANY treatment. I recommend methadone for those people because of the structure provided by methadone programs.

No matter how buprenorphine is dosed, most of the medication ends up swallowed. It does not get broken down in the stomach. If that was the problem, we would simply give people buprenorphine tablets with an enteric coating, as we do with many other drugs. The problem is 'first pass metabolism'. Buprenorphine is absorbed in the intestine and transported to the liver by the portal vein, along with everything else that is eaten. Some meds, including buprenorphine, are metabolized so efficiently that none of the medication makes it to the exit of the liver. There are many other examples of first-pass metabolism, including zolpidem (Ambien), where the first-pass effect is very strong but not complete. That's why, though, sublingual zolpidem is so much more potent than swallowed zolpidem. BTW, do NOT start taking your Ambien sublingually. If you do, you will quickly increase your tolerance, and it will never work if you take it normally.

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Re: Dr Russ' Suboxone Protocal

Post by Amy-Work In Progress » Wed Jun 13, 2018 1:00 pm

Thank you, Dr. Junig for clarifying information about what happens when buprenorphine is swallowed. I have no idea, Krisopiate, why you believe that the buprenorphine that is swallowed has further effect on receptors in the brain. If that were the case, why wouldn't we just swallow our buprenorphine in the first place?

I also don't know what you mean in this statement:

"in short my experiences are that Suboxone is in fact more activating than Methadone. Never underestimate just how activating Suboxone is, and be aware that suboxone is an antagonist at the Kappa receptor which is responsible for its antidepressant effects plus increased focus and concentration. Yes it is a slightly different feeling to full agonists but that is because it has these Extra effects. I also don't think Suboxone is a partial agonist, only perhaps accurately classified as a partial-agonist due to its ceiling effect and good safety profile. But on paper and in opiate comparison tables you will find that Buprenorphine is 20 to 40 times the strength of Methadone."

What do you mean by "activating" in this context? And what gives you the idea that buprenorphine is not a partial agonist? I'm not understanding your thinking. And the ceiling effect of buprenorphine makes comparisons to other opioids/opiates quite difficult.

Amy
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Re: Dr Russ' Suboxone Protocal

Post by Amy-Work In Progress » Wed Jun 13, 2018 2:38 pm

Kriso, I also think it would be advantageous for you to read this blog post about opioid equivalencies. Comparing buprenorphine with other opioids is like comparing apples and oranges because of buprenorphine's ceiling limit. You said:

"But on paper and in opiate comparison tables you will find that Buprenorphine is 20 to 40 times the strength of Methadone."

After reading the blog post from Dr. Junig, perhaps the comparisons will be more clear to you.

http://suboxonetalkzone.com/brandeis-an ... pdmp-data/

Amy
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Re: Dr Russ' Suboxone Protocal

Post by Krisopiate » Tue Jun 19, 2018 12:16 am

...Yeah I thought it would still have some effect in the stomach. It only makes sense to me. One-day I will try it, if I return to Suboxone.

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