Really hoping someone can give me advice on new pain med.-SUBOXONE

I'm gone to try and make this short and sweet.  My husband has major damage to his lower back (he needs surgery and is not willing to have it till its a last resourse).  He goes to a pain clinic every 2 months and has some kind of injections done in his lower back.  He starting these injections about a year ago and they do give him relief but not for as long as they initial did.  He is a Truck driver so he can not take pain meds till he gets home and by then (usually he works approx. 14 hr days) the pain is pretty bad.  He only takes one vicoden a day and hates to have to even do that.  The Pain Mang. dr. now wants to put him on this new drug that he thinks will really help him.  The name of this drug is Suboxone.  We researched it on line and found out that its used to help people to kick addiction.  His Dr. did tell him to research it and that the FDA has now approved this drug for use in patients with my husbands problems and it suppose to work good.  What I read scarred the crap out of both of us.  This sounds like a heavy duty pain med. 

Does anyone have any knowledge or experieces with this drug?  Please, any input would be GREATLY appreciated.

Suboxone is really not a "front line" drug for pain management and, in my opinion, it's is a huge leap for someone that's maintaining any level of functionality on 1 Vicodin a day. One thing your husband will need to be very aware of is that you don't use Suboxone on an "as needed" basis or just when he's not on the job. It has to be taken exactly on the schedule the doctor gives him, whether he's working or not.

What exactly is the nature of the damage to his back? And what type of surgical intervention has been suggested?

Hello Patsy,

AS a Chronic Pain patient with back pain and a patient who takes Suboxone for pain releif, I would recommend NOT starting on Suboxone if he's a truck driver and only takes one vicodin a day. It does have a very potent pain med in it, Burprenorphine which has been around forever, but they use it in MICROgrams for pain relief in other countries for severe pain. This is a BIG jump in pain meds, actually a huge jump. And it does havet he same side effects as any other opiates, atleast to me it does. The drowsiness is still there, even after a year and half of taking it. And lots of people dont find good pain releif with it, I just got lucky with it as it's done wonders for my pain.

Also, what IF (hoping to God this never happens to your husband but what IF?) he's in an accident, and needs emergency pain relief and/or surgery, Buprenorphine (suboxone/Subutex) blocks other narcotics from from working, they have to give a HUGE amount while watching his breathing (full blocking can start around 4-6mgs). This alone can cause issues if he's dying in pain and he gets an ER doctor that doesnt know squat about how Suboxone works and your husband ends up suffering tremendously. It happens all the time, I've heard many horror stories.

But I'm not saying this may not be a good pain med for him, it just might be. It has about the same side effects as other pain meds, but lots of people have reactions to the naloxone in it, but this can be helped by switching to Subutex which is just the Buprenorphine by itself, or spitting out the saliva while sucking on the suboxone. Also the naloxone has no effect (unless your allergic as a VERY tiny amount does pass through the body, but not enough to cause withdrawals as buprenorphine is much more binding then even the nalxone/naltrexone) and it does have a peak dose where taking more will do absoutly nothing else, they say usually that's at 32mg, but some doctors say it can be as low as 6mg, so overdosing on it is very rare.

Also you must remember that it's 25-50 times stronger then morphine, so it's not something to mess around with. They are working on trials on doing a patch of buprenorphine which will be FDA approved just for chronic pain here in the states. I just dont understand why a doctor would recommend this for pain when he's taking just one vicodin a day, But they're the doctor, not me.

But just in case you havent checked this place out yet, go to the NAABT websight which is full of all the information about Buprenorphine you can dream of, and they even can send you a free package of information all about it, it comes in a white folder which has papers with illustrations and a CD to listen to and bruchures, they dont sell anything, they're just there to inform people about Buprenorphine treatment and they have a section on it's use of Suboxone/Subutex for pain.

If I where you, I would defiently get a 2nd opionion if this doctor doesnt offer any other options and just offers Suboxone. Their's so many other better options out there, especially with him driving for a job. Well if you have any other questions, just let me know, I'll be happy to answer anything.

-Carmen

PS, please dont take anything I say over what a doctor says, as I'm not a medical perfessional or have absoutly any training in the medical field. I'm just stating my personal experieince with Suboxone, and as we all know, everyone has diffrent experiences with diffrent medications, what works for me may or may not work for the next person.

Suboxone stays in the system for 37 hours, so no, he cant take one and it be out of his system 12 hours later, some people take it this med once daily or once every other day cause it stays in the system so long, but yet the pain relief only last 4-6 hours.

-Carmen

My suspicion is that the doctor suggested Suboxone because it's possible to skirt the DOT drug testing requirements while using it. At low enough doses (and one would expect a very low dose coming up from 1 vicodin a day), the test would technically be positive, but it would come in below the minimum concentration allowed, so it would be considered "negative."

If your husband never tests a true positive on a drug test, then doctor doesn't have to put himself on the line and go on the official record as saying your husband is safe to drive while using a controlled substance.

But that's just a suspicion.....

Patsy,
i haven't posted to this thread because I'm not as familiar with suboxone as other members of the forum, but I can say there's no way there won't be a paper trail for any of these medications.

If they're being taken as prescribed, and are safe for your husband to take with his occupation, then an employer should be ok with it, if that's what you're worried about. I'm not saying stuff doesn't happen that shouldn't, but a doctor can't keep this out of his records. Nor if you use your insurance can it be kept from insurance records, pharmacy records, etc.

Are you concerned just because of your husband's employment?

PaLady

If you really want the truth about Subs go to drugs.com. And you can read stories from hundreds strugling to get off this med. there are more then a handfull of pain killers out there I would try before subs.

In fact any doctor that would suggest it knowing what he is currently rx'd  is looking for that vacation bonus the suboxone sales rep tried pitching. Thats just crazy!

Tell your husband to hang in there. I feel for you both. There are Long acting meds that he could benifit from but can't because of his job. Tough one.

I would suggest Lyrica if his problem is anything nerve related.  JM2C

 

Post Edited (painsnbody) : 10/15/2009 2:38:02 PM (GMT-6)

Suboxone is a combination of buprenorphine (very strong opioid - somewhere between oxymorphone and fentanyl) and naloxone (sometimes called narcan - basically blocks opioid medications from binding to opiate receptors in the brain). It's only been FDA approved to ween opioid/opiate addicts or used as a maintenance drug so addicts don't feel the need to revert to a more dangerous drug. I saw Subutex mentioned above, note that they are NOT the same. Subutex is just buprenorphine while Suboxone is the buprenorphine/naloxone combo.

Anyways, unless your doctor thought he may be acquiring an addiction issue, there's no reason he should have considered prescribing it (unless your husband is actually taking stronger opioids or more than one vicodin/day). This drug is meant to keep heroin addict's cravings at bay, so it's powerful. Even half of a sub-lingual tab would be enough to knock out some one 200+ lbs. with little tolerance (a MAJOR driving hazard). If you have told us the full story, you should consider seeing a new doctor.

uniquelyme,  thanks for your input.  I just lost my job at one of what use to be the "big three" so it's kinda hard for him to retire right now.  Were going on Monday to meet with his pain dr, and asking for alternatives for him.  I would think he could at least try something else before going to that extreme.  Fortunetly if worse does come to worse he has the time to retire.  He won't even discuse with anyone the topic of surgery right now.  He says that till he can't function at all is when he might consider having surgery.  I also have several health issues and have had dr., husband and family tell me to fill for disability but have fought it off for sometime now, but maybe it's time to listen.  Thanks again for your concern.

"What doesn't kill us, only makes us stronger" (right?)

Patsy,
I don't know for sure (as I said earlier, I don't know much about suboxone) but my hunch is the doctor may - legitimately - be concerned not just for his own liability, but your husband's safety, considering his occupation. I'm not sure you're going to find medications that don't affect your husband's alertness, and that a doctor is willing to put him/herself on the line for. As I said above, there is no way a medical professional can legally or ethically keep this information out of a medical record. No way there won't be a paper trail, and that is as it should be. Medications for pain aren't something to fool around with when it comes to driving, and I know your husband was holding off taking the vicoden until he got home, but the suboxone can't be taken the same way.

It looks to me like your husband has some fairly significant problems in his lower spine, and I know neither of you want to hear this, but driving a truck (the sitting, the jolting, pressure on legs and lower spine) for all those hours is probably aggravating it all. I'm not saying he necessarily needs surgery (I've had a double lumbar fusion, and I still have difficulty standing and sitting) but he may need other treatment, and may need to at least make adjustments in his work. NONE of us ever wants to hear that. I'm still struggling with accepting the changes that have come to my life because of my health issues. But please remember the doctor (and others - pharmacists, etc.) are on the line for what they prescribe, and that PM doctor may be doing the only thing he believes he can safely do. Certainly, you can seek another opinion, but I also think you need to begin accept the realities for the doctors involved in prescribing. I have a feeling you may accept them easier than your husband, as you say he is stubborn. We're all stubborn in our own way when it comes to making major changes in our lives.

You may have stated it somewhere and if so I apologize for missing it, but has your husband ever tried physical therapy, or any other treatments? A good PT can also help figure out what's possible for someone with your husband's occupation - and what's not.

Also - is your husband on any of the anti-depressants that are also used for pain? They tend to be less sedating - some not sedating at all. Might be worth asking your PCP about a medication like cymbalta, which can help with nerve pain.

Just some thoughts. Don't know if they helped or not.

Take care,

PaLady