hairgirl

Look it up online.WebMD always has helpful info.

exjunky

Jane -- no I think you misunderstand me.

If you take opiates while on suboxone OR naltrexone, you simply will not feel the opiates. No pain, but no 'high' either. Both drugs are an opiate blocker, although they work on slightly different principles.

The pain that I was referring to is what happens when somebody with a large opiate habit (whether it's heroin, oxycodone, or whatever) takes a dose of naltrexone intraveneously. It throws them instantly into withdrawals, and I do mean INSTANTLY. It's like the opposite of a heroin rush: instead of a rush of pleasure, it's a rush of pain.

When I said "do the naughty thing" I was making a euphemism for using needles.

A little off topic, but important to understand: There is only one difference between Suboxone and Subutex: they both have buprenepherine, but Suboxone has the naltrexone to prevent junkies from trying to shoot it. So the soccer mom with an oxycodone habit will get Subutex, since it's unlikely she will suddenly turn into an IV drug abuser. But somebody like myself goes to the same doctor, he sees my track marks, and knew that I was not a Subutex candidate, I needed the "booby trapped" version.

After thinking about it, I think I can see the wisdom in naltrexone. MAYBE ... it's not to get somebody off of opiates, but rather to KEEP them off of opiates. If an addict takes naltrexone every day, they will be unable to get high. They can TRY to relapse, but to their disgust they will find that opiates no longer have any effect on them. With naltrexone in your system, you could eat a bunch of oxycodone (or whatever) and it would seem to do nothing at all to you. (That's just a hypothetical... please don't try it for real.)

exjunky

Let me also emphasize again I am not "anti-naltrexone" and not trying to talk anybody out of using it. It's just like that I like to understand how these therapies work on a biological level, and in this case I find it somewhat confusing.

But if I tell you one thing and a doctor tells you another thing, listen to your doctor.

xjunkie4u

If you are addicted to opiate narcotic drugs, naltrexone or narcan will make you so sick. Sure it may save your life in an overdose but when you wake up in a ER after a narcan shot the last thing you feel in gratitude. Theses drugs are sometimes given to addicts when they are awake by a cruel or unaware paramedic nurse or doctor and it's extremly hurtfull. I hope nobody had to experience this. Another problem with these drugs is that if you are on them and get into an accident or need emergency pain relief, you could be SOL. All the best

bval

Just to sum it all up here for everyone, and to get some things straight here:

Naltrexone is what is known as an opioid antagonist. It is basically the exact OPPOSITE of the Opioid/Opiate drugs (also known as opioid agonists) we all know and love. When introduced directly into the bloodstream, it will 'knock off' any opioid drugs from one's opioid receptors.

There is therapeutic use for this drug in cases of overdose on narcotics, it has saved many people's lives by rendering the narcotics in the system 'neutral' if you will. But when it is used for this purpose in this way, it will instantly throw an ADDICT into massive withdrawals, IOW, IF one would NORMALLY experience withdrawals ANYTIME they WEREN'T on narcotics.

However, if you shot heroin for the first time in your life, OD'd, and went to the hospital and got shot with this drug, you'd wake up and most likely feel fine. It's only active opioid ADDICTS who are at the time of injection ON narcotics who experience the horrific w/d effects from a naltrexone shot.

Naltrexone helps alcoholics stay clean from alcohol by blocking the pleasant sensations from drinking. This is because alcohol, especially in people genetically predisposed toward alcoholism, triggers the body to release extra endorphins - which is what opiates themselves mimic and hence why they give us such pleasure. Endorphins are our natural feel-good chemicals, and they also attach to our opioid receptors.

Now, its my understanding that some say this drug actually made them want alcohol less acutely when they were quitting, but the mechanism of this effect is scientifically unknown. It seems it's just 'lucky for them' as far as science has been able to establish, and this is not an effect that one can count on being true across the board.

For reasons that should be obvious, naltrexone can be used to help opioid addicts stay clean by essentially the same mechanism as it works for alcoholics. It keeps one from feeling the pleasure of the drugs they use by blocking the attachment of opioids to one's opioid receptors. Note that it would only be used in this way once someones system had been completely cleared of residual narcotics, and they were feeling at least mostly well again.

Now, while the descriptions of suboxone and subutex and how that all works above are basically accurate, the fact of the matter is it is NOT Naltrexone that is in present in Suboxone, but rather Naloxone, a different but less powerful opioid antagonist. But again, the principles described are correct.

I should think, based on my knowledge of the action of Naltrexone, that the only side effects would be a 1) a slight increase in perception of pain, and 2) a slight DECREASE in one's ability to feel a strong sense of pleasure from things that might ordinarily give one a bit of a rush. Things like sex, winning at gambling, that feeling you get after a hard work out. All natural highs if you will are dependent upon one's endorphins/opioid receptor system working, and if one has naltrexone blocking one's receptors, it's not just going to be 'artificial highs' that are inhibited, but at least to some degree, one's 'natural highs' pretty much HAVE to be as well.

But I am not a doctor, so is all just a guess based on things I've read over the years. I encourage anyone interested in confirming anything I've said to consult a doctor or otherwise do their own research into the subject.

bval

Oh, one more thing to clarify:

It is not MORE physically dangerous for one to take narcotics while taking naltrexone, in fact, it would technically be SAFER to take narcotics while ON naltrexone than while NOT on naltrexone.

Why? Because ON naltrexone, narcotics simply will not work. They will do NOTHING. No, one will NOT be kinda 'high without knowing' it as was suggested above. One can most certainly NOT overdose more easily on narcotics while on naltrexone, though it would theoretically still be possible to do so given the infinite ratios of the amounts of antagonist vs. agonist one could have in one's system.

The 'neutralization effect' of a strong opioid antagonist like naltrexone over an agonist is basically 'total'. That's WHY they give it to people who are overdosing and it revives them and saves their lives, you see?

And the only time that taking naltrexone along with narcotics causes withdrawals is in persons who would be in withdrawals if they weren't on narcotics, i.e. active addicts.

Again, not a doctor, look it up for yourselves or ask a real doctor. Pretty sure I know from whence I speak, though.

exjunky

That's exactly what I went through and why you can detect some bitterness when I discuss the subject.

The paramedics brought me out of an overdose with Narcan and an oxygen mask, like they are supposed to, and while I felt delirious I was not in any serious pain. Then they took me to the hospital "for observation", and all the while in the ambulence I was sincerely grateful and telling the paramedics how thankful I was for their work.

Once I got to the hospital they hooked me up to an IV bag. At this point I felt perfectly fine, but I figured I'd let the doctors do whatever they want to do, after all, they're the experts, and I was in such a state of gratitude and was praising God that I was even alive.

A few minutes later, some scrub walked up to my IV bag and fiddled with it, and walked away. Immediately I started to writhe in pain. I started screaming for help--I had no idea what was going on. Is this what's it's like to have a heart attack, or an organ failure? I had no idea, all I knew is that the pain was unbearable, and I honestly thought that death was imminent.

I screamed out for help "I'm dying over here!! HELP!!" The scrub turned around and actually laughed at me, "Oh, you're dying, are you?" and he started to chuckle. Then he explained in a smarmy tone, "I gave you a little naltrexone to knock the last of the heroin of your system." As soon as he said that I started to try to remove the IV hemoclamp from my hand, but they had it taped down really well. He saw what I was trying to do and held me down and called for help. It was too late anyhow, the dose was already in my bloodstream. To this day I do not think this person was acting in the interest of my wellbeing, I think this guy was a sadist who actually enjoyed seeing me suffer, as if to say "It serves you right for being a lowlife junky scum."

So when I cringe at the word naltrexone, that's why.

Impurrfect

exjunky - I'm sorry you were treated so badly in the hospital.

I was an ER nurse and we did give "Narcan" to anyone who was in acute overdose and it was unknown whether opiates were taken. There were several times when the person would wake up but Narcan has a short span of effectiveness, and if they went back out, we would have to give it again.

Once a person was stable and their breathing was okay, we would often give a small dose of benzo to calm them. This wasn't always possible, though, because some would get relaxed enough to stop breathing.

I actually never realized it was given outside of the ER until I came here....learn something new every day. From what I can see, Narcan, Subutex, Antabuse - all those can benefit a person if they really want recovery. But if someone doesn't really want to stop, wouldn't they just stop taking the med?

BV - a question...my stepsister is on subutex by her addictionologist but he is allowing her to take fioricet and lortab when absolutely necessary for chronic pain. I understand she doesn't get high from it, but does she still get pain relief?

Thanks!

Amy

exjunky

bvaljalo -- Bravo, everything you said is spot on. If naltrexone is in your system, opiates like heroin will float around harmlessly in your bloodstream, unable to find any receptors to bind to, while the naltrexone has them all hogged up.

By the way, I tried to start a discussion some time ago about the science of how opiates work, including opiate antagonists like naltrexone. It was met with mixed reactions, but I personally I think that education is an important weapon in the fight against addiction. Here's the link for those who missed it - http://www.soberrecovery.com/forums/...ates-work.html

Impurrfect -- Yes, I've heard of that. If methadone is responsible for the overdose there is a special danger present, because methadone lasts so long, there is a possibility of the Narcan wearing off before the methadone does, therefore triggering a second overdose. It's especially hard when dealing with street drugs, since the addict never knows exactly what's in those little stamp baggies. Even if the patient swears they were taking heroin and only heroin, how do you really know? In retrospect, maybe he really did think that he was doing the medically responsible thing. But I'm not joking when I say he chuckled at me while I writhed in pain--if that's not the very definition of a sadist, I don't know what is.

Impurrfect

exjunky -

I know, I worked with some people like that. I'm just glad I wasn't because I became just like the people I took care of.


Amy

bval

Kinda tough to say for sure Amy. Kinda depends on how much subutex she's taking vs. how much lortab she would take in the situation of extreme pain.

Subutex is NOT naltrexone, of course, rather it's a very unique opioid in that it's what's called a partial agonist with some antagonist qualities. Sounds kinda impossible, but you see, one has more than one type of opioid receptor and ... well, it gets kinda complicated when you get down to what happens when one mixes bupe with regular opioids like hydro. And to be honest, I've never personally investigated any other aspect of the interaction besides trying to get HIGH on other opioids while I was on bupe ...

Bottom line, I'd suppose it's *possible* she may get a little extra pain relief from a normal therapeutic dose of lortab (7.5-10mg) while on bupe, but frankly I think it's pretty unlikely to do much of anything unless she was on a real low dose of bupe (i think like <2mg/day would be a reasonable guess, but still nothing more than a guess).

I just haven't done much research regarding the efficacy of regular short-acting opioids while taking bupe as far as pain goes ... either on my own self, nor in my reading.

I'd be inclined to say I really don't think the risk of having a bottle of lortabs around is justified by the potential benefit of the pain relief they might provide when mixed with bupe. Bupe is a pretty solid painkiller all on it's own is the truth...

2ala2

You are very misinformed my friend. You will go into OD without even feeling it. It has happened a few times to people I know.
Check out this link. There are also many more:
http://www.mja.com.au/public/issues/...b10356_fm.html
and here's what the Mayo clinic had to say:
http://www.mayoclinic.com/health/dru...ation/DR601877
check out the part under "precautions"

2ala2

One more thing:
Two of these people have died attempting to override the blockade. I also remember clearly my doctor stressing that i should NEVER try to do this and that it is very deadly. I was on Revia (brand name) was also on Trexane earlier.
Naltrexone administered for revival works entirely differently than used as an Opiate receptor blocker. My advice is not to try to make 'logical' deductions here. You can actually kill somebody with your advice.
Go ask your doctor.

exjunky

2ala2 I think you have a very good point but at the same time I don't think he is "very" misinformed. He is repeating what is accepted medical knowledge. In fact the very first sentence of the report you linked to reads:
And then the article goes on to document a handful of cases which seem to fly in the face of this accepted belief. Of course it only takes one single exception to cast doubts on a theory, so in that sense you are 100% correct.

Biology is not an exact science anyhow; even in 2007 the workings of the human brain are still largely a mystery.

In any case, the difference of opinions here is starting to become highly academic, and starting to drift from the real purpose of the discussion, which is getting off opiates and then staying off opiates.

2ala2

Look XJ,
I don't think it's Kool to imply to active addicts that you can go ahead and do Opiates while on a serious medication such as Naltrexone, or that it's ok to take 29 pills because you know someone that did 90 and survived.
How academic is that?

Also, with regards to the quote: take a look at the Mayo Clinic precaution.

exjunky

2ala2, I think the Mayo Clinic quote you are mostly referring to is this
That is absolutely correct, but it does not contradict what bvaljalo said. It seems to me that you misconstrued this statement to mean that naltrexone increases sensitivity to opiates, or increases the likelihood of an overdose; but that's preposterous. Quite the opposite is true. It's the therapy which increases sensitivity, a therapy that involves quitting opiates.

It is a common fallacy among addicts that if you take an exceptionally large dose of opiates you can overcome the blocking effects of drugs like naltrexone. There are two problems with this notion. First, it's extremely dangerous, and you might overdose anyhow. But to an addict who puts getting high first, and health concerns last, that argument is not very convincing. However there is another much more compelling argument that even the worst addict can appreciate: it simply doesn't work! No amount of opiates, no matter how large, will get you high if you have enough opiate blockers in your system.

Come now, nobody on this thread recommended anything even close to that. I can appreciate your concern that somebody might misinterpret something posted here, and overdose as a result of it. I would hate for that to happen as well.

So let's try to clear the air and summarize this in a nutshell. I think a fair statement that we can all agree on is this:

"If you take a large amount of opiates while on an opiate blocker like naltrexone, you will definitely not get high, but it's possible you will die."

Peace,
X-J

bval

Your complaints about my posting seem to be a misinterpretation of what I've said, specifically this:

One can most certainly NOT overdose more easily on narcotics while on naltrexone, though it would theoretically still be possible to do so given the infinite ratios of the amounts of antagonist vs. agonist one could have in one's system.

You appear to be locked into being critical of the first part of my statement, WITHOUT stopping to really PONDER the LATTER part of my statement. The second half of the sentence ABSOLUTELY addresses the point you're attempting to make in your criticism.

Here's the friggin point, bottom-line, this is FACT and I'd LOVE to see you prove me wrong:

Take a person. Addict, non-addict, clean, using, WHOEVER.

Put them on Naltrexone.

Now proceed to administer to them an opiate drug and continue giving them more until they die. Let's call this lethal amount X mgs.

Now magically revive our same person, just for the sake of scientific control. Let time pass ...

Once they are back to where they were before we started out little test, we perform another experiment on our little human guinea pig ...

Only this time, let's DON'T give them any Naltrexone, and proceed to administer an opiate drug until they die again. Lets call this lethal amount Y mgs.

The point of my statement is that, in fact, in NO CASE, NO WAY, NO HOW will quantity Y EXCEED quantity X.

THAT, my friend, is the point that my statement is trying to make... THAT, and nothing more, really.

Perhaps, though, I should have qualified my statement slightly so as to make it more clear, since obviously it was open to misinterpretation as you have done. So here you go:

ALL OTHER THINGS BEING EQUAL, it take MORE OPIATES to overdose ON naltrexone than it takes to overdose NOT ON naltrexone. Thus, it is NOT EASIER to overdose while ON naltrexone.

That not only makes it more clear for everyone, but it also does NOT in any way contradict what I said originally. You chose to interpret the word 'easier' in a different way than I meant it, so by definition I was UNCLEAR, thank you for giving me the opportunity to clarify my meaning.

So now we can both be happy. RIGHT?

By the way ... I already apologized about the 29 pill post with is on another thread, but just as an exercise to show you what my point there was, ponder the following scenario:

Jill is pondering taking 4 pills containing oxycodone today, but since she knows this is enough to kill her, she decides to open her other bottle of pills containing codeine and she takes 29 of them.

Now ... you tell me ... does Jill overdose and die? Explain why she does, why she does not, OR why there is no way to tell based on the information given.

And when you correctly figure out the answer, you'll have figured out my point in the post about the 29 pills ...

But I DO admit that in that particular post, I was careless in how I expressed that point which I've already apologized for and clarified....

2ala2

Thank you all for your clarifications.
Please don't make it harder on the suffering addict. Some might find it hard to do the math, to make elaborate equations, and to come up with your enlightening conclusions.
Keep it simple.

bval

Thanks for instructing me on how to properly utilize this forum.

My intention in the post you took issue with was *exactly* to simplify and bring together all the information contained above.

With all due respect, you were equally culpable in complicating this thread.

And in my humble opinion, you are failing to do the responsible thing and admit that I was not *WRONG* ... which you strongly implied that that I was by saying I was misinformed and that I should look something up.

But I won't take your inventory...

exjunky

:horse While you two hug and make up let me try to summarize again for the two classes of people who might be reading this thread:

To actively using opiate addicts

Here's what the addict needs to understand about opiate blockers: you can't cheat them. You can't overcome the effects of an opiate blocker by taking a bigger dose than normal. It sounds plausible, but it just doesn't work. I could get into the science of why it doesn't work, but I'll spare you and get to the bottom line: YOU WILL NOT GET HIGH, NOT EVEN ONE LITTLE BIT. This is not a lie designed to fool addicts into not using, it's a scientific fact, it's the God's honest truth.

And just to give that dead horse one more swift kick, let me add that just because you can't get high, that doesn't mean that overdose is impossible.

To recovering opiate addicts

There are some methdods of recovery that involve naltrexone, but they first require that you get off of opiates one way or another, be it by tapering, cold-turkey, suboxone, methadone detox, a prison sentence, or whatever works.

The naltrexone doesn't get you off the dope, it KEEPS you off the dope. In one of the more radical procedures an implant is surgically placed inside your arm and then they sew you back up, so that a stream of naltrexone flows into your bloodstream 24/7. Now if you find yourself in a moment of weakness, and you decide you want to see the dope man for a fix, well my friend, you are up that famous creek without a paddle. There's nothing you can do to get high. Getting high has not become "more difficult" or "more expensive", it's become impossible.