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Also, all forms of buprenorphine (aka Suboxone) often end up being a heroin substitute rather than weaning the addict from heroin. Kinda like how Oxy functions

Also, all forms of buprenorphine (aka Suboxone) often end up being a heroin substitute rather than weaning the addict from heroin. Kinda like how Oxy functions in real-world application. The difference is, Suboxone is mandated in alternative sentencing programs by the judiciary of certain states. And in some states, with no consideration of whether the addict was addicted to opiates/opioids.

mattnewton 8y ago
Do you have a source on that last part I could read more about? The idea of a court mandating opiate treatment because someone smoked weed is terrifying.
- monochromatic 8y ago
  Yeah that seems... implausible.
- devin 8y ago
  I'm assuming he means people who are caught with opioids who are not necessarily addicted to them.
drooogs 8y ago
plenty of people successfully use buprenorphine to taper off heroin. some people do end up going on long term buprenorphine maintenance, but the harm there is radically less than an active oxy/heroin addiction. even in the worst case scenario, any day that an opioid addict takes buprenorphine is a day where they have far less risk of fatal overdose.
- stochastic_monk 8y ago
  Exactly. Additionally, methadone increases cardiac mortality by increasing the QT interval, so the drug with better efficacy and safety profile should fully replace it. Buprenorphine is good. And someone can’t get on it if they’re too addicted to opiates because as a partial agonist it can precipitate accelerated withdrawal, which acts as a protective mechanism, I imagine.
  - mveety 8y ago
    Buprenorphine also increases cardiac mortality by increasing the QT interval. Buprenorphine is used over methadone mostly because its a partial agonist of the mu-opioid receptor which basically limits how high you can get.
    - stochastic_monk 8y ago
      You’re right! I hadn’t known that buprenorphine also caused it, but it seems all of the drugs used for that purpose. I did find a 2013 study stating that the effect was significantly less than that from methadone, but it’s good to know that both come with cardiac risks.
- mveety 8y ago
  I would disagree that buprenorphine is safer than oxycodone or pharmacologially pure heroin. Buprenorphine has more dangerous potential side effects than either of them, meaning it would be safer to use heroin or oxycodone. Also, the reduced risk of overdose isn't because of the drug, it's because the user isn't dosing it themselves.
  - drooogs 8y ago
    > Buprenorphine has more dangerous potential side effects than either of them genuinely curious, what are these? > the reduced risk of overdose isn't because of the drug it is significantly harder to overdose on buprenorphine, especially in formulations that contain naloxone.
    - pharrington 8y ago
      Well, the answer to this particular unasked riddle is to just administer the naloxone.
      - drooogs 8y ago
        works great unless the person is alone. then they die.
- superkuh 8y ago
  It also drastically decreases the likelyhood of potential harm from the government's use of violence in it's drug war. This is not an insignificant part of the danger of opioid use.
mveety 8y ago
This happened to a friend of mine. He does heroin recreationally and isn't addicted and doesn't get withdrawal symptoms. The court mandated he go to treatment and was basically required to take buprenorphine during treatment regardless of him needing it. The treatment facility also didn't believe him when he told them how much he used and thought he was still using in the facility because he didn't have withdrawal symptoms even though the drug tests said otherwise.
- tmp-20150107 8y ago
  Seems dubious. On the methadone program I'm on, before they could start the treatment, I had to take multiple toxicology screens to show I was addicted to heroin. These places are incredibly worried about opiate-naive individuals overdosing, which can happen even with the small initial doses on these programs. Note that this is in the UK, which has a much less litigious medical culture USA as well... Not to cast aspersions on your friend, but have you considered that he may be lying to you about only using recreationally, and using this story to explain why he's on a treatment program? One thing about heroin is that it's pretty much impossible to use regularly without becoming addicted. As a heroin addict myself I know that unfortunately deception can easily become a normal part of your life.
  - fapjacks 8y ago
    Seems dubious. A test to show you are addicted to opiates does not exist, and also your own experiences do not represent the experiences of every person that ever used drugs.
    - tmp-20150107 8y ago
      Yes, technically the tests are to show the opposite - that you are (not) opiate naive. Someone who can pass multiple closely spaced toxicology screens for heroin (i.e. opiates are not detected) is never going to be admitted to one of these maintenance programs due to the incredibly high risk of death by overdose.
  - wavefunction 8y ago
np_tedious 8y ago
It is not comparable oxycodone. Oxycodone (present in oxycontin and percocet) is a full opioid agonist. Buprenorphine is a partial agonist and actually blocks most of subsequent opioid's effects. The patent is still bullshit

mattnewton 8y ago

Do you have a source on that last part I could read more about? The idea of a court mandating opiate treatment because someone smoked weed is terrifying.

monochromatic 8y ago
Yeah that seems... implausible.
devin 8y ago
I'm assuming he means people who are caught with opioids who are not necessarily addicted to them.

drooogs 8y ago

plenty of people successfully use buprenorphine to taper off heroin. some people do end up going on long term buprenorphine maintenance, but the harm there is radically less than an active oxy/heroin addiction. even in the worst case scenario, any day that an opioid addict takes buprenorphine is a day where they have far less risk of fatal overdose.

stochastic_monk 8y ago
Exactly. Additionally, methadone increases cardiac mortality by increasing the QT interval, so the drug with better efficacy and safety profile should fully replace it. Buprenorphine is good. And someone can’t get on it if they’re too addicted to opiates because as a partial agonist it can precipitate accelerated withdrawal, which acts as a protective mechanism, I imagine.
- mveety 8y ago
  Buprenorphine also increases cardiac mortality by increasing the QT interval. Buprenorphine is used over methadone mostly because its a partial agonist of the mu-opioid receptor which basically limits how high you can get.
  - stochastic_monk 8y ago
    You’re right! I hadn’t known that buprenorphine also caused it, but it seems all of the drugs used for that purpose. I did find a 2013 study stating that the effect was significantly less than that from methadone, but it’s good to know that both come with cardiac risks.
mveety 8y ago
I would disagree that buprenorphine is safer than oxycodone or pharmacologially pure heroin. Buprenorphine has more dangerous potential side effects than either of them, meaning it would be safer to use heroin or oxycodone. Also, the reduced risk of overdose isn't because of the drug, it's because the user isn't dosing it themselves.
- drooogs 8y ago
  > Buprenorphine has more dangerous potential side effects than either of them genuinely curious, what are these? > the reduced risk of overdose isn't because of the drug it is significantly harder to overdose on buprenorphine, especially in formulations that contain naloxone.
  - pharrington 8y ago
    Well, the answer to this particular unasked riddle is to just administer the naloxone.
    - drooogs 8y ago
      works great unless the person is alone. then they die.
superkuh 8y ago
It also drastically decreases the likelyhood of potential harm from the government's use of violence in it's drug war. This is not an insignificant part of the danger of opioid use.

mveety 8y ago

This happened to a friend of mine. He does heroin recreationally and isn't addicted and doesn't get withdrawal symptoms. The court mandated he go to treatment and was basically required to take buprenorphine during treatment regardless of him needing it. The treatment facility also didn't believe him when he told them how much he used and thought he was still using in the facility because he didn't have withdrawal symptoms even though the drug tests said otherwise.

tmp-20150107 8y ago
Seems dubious. On the methadone program I'm on, before they could start the treatment, I had to take multiple toxicology screens to show I was addicted to heroin. These places are incredibly worried about opiate-naive individuals overdosing, which can happen even with the small initial doses on these programs. Note that this is in the UK, which has a much less litigious medical culture USA as well... Not to cast aspersions on your friend, but have you considered that he may be lying to you about only using recreationally, and using this story to explain why he's on a treatment program? One thing about heroin is that it's pretty much impossible to use regularly without becoming addicted. As a heroin addict myself I know that unfortunately deception can easily become a normal part of your life.
- fapjacks 8y ago
  Seems dubious. A test to show you are addicted to opiates does not exist, and also your own experiences do not represent the experiences of every person that ever used drugs.
  - tmp-20150107 8y ago
    Yes, technically the tests are to show the opposite - that you are (not) opiate naive. Someone who can pass multiple closely spaced toxicology screens for heroin (i.e. opiates are not detected) is never going to be admitted to one of these maintenance programs due to the incredibly high risk of death by overdose.
- wavefunction 8y ago

np_tedious 8y ago

It is not comparable oxycodone. Oxycodone (present in oxycontin and percocet) is a full opioid agonist. Buprenorphine is a partial agonist and actually blocks most of subsequent opioid's effects. The patent is still bullshit