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Unread 07-27-2008, 02:42 AM   #1
Madison7
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Default Relative strengths..bup,methadone, and morphine

I have read where bup is 25 - 40 times as strong as morphine. I know that methadone is stronger than morphine but the comparison is clouded by the short and long terms of the two. I would put methadone as 5 times as strong as morphine on a daily dosing basis. Based on what I have read, bup is several times stronger than methadone. Why is it then that high dose methadone patients are advised that they may not be candidates for bup when bup is so much stronger?

PS: This is not a bup put-down. I am happier with it than I was with methadone.

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Unread 07-27-2008, 05:24 AM   #2
josie
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When taken out of context the statement that bupe is 50x stronger than morphine is very misleading and confusing. Here is an explanation that has been posted by suture:

The 50x thing is only at very low doses <1mg. 20mgs of sub is not equal to 1000mgs of morphine. Here's a post where I explained that:

quote:
--------------------------------------------------------------------------------
Originally posted by Suture

Great point Sheryl. Buprenorphine is more complicated than regular opioids and it’s easy for people to jump to conclusions without a full understanding. This is why we have some odd claims that contradict what the doctors and scientists say. Sub is potent but has a ceiling to its effects. At low doses (below 1mg.) bupe is 20-50 times as potent as morphine, (Tip 40) which is why it has been used as an analgesic. But then people mistakenly conclude that because of that it is harder to get off of, and that is wrong. Because of the ceiling effect at 16mgs it is much less potent than morphine. This can be confusing until the ceiling effect is explained. Direct comparisons between buprenorphine and other opioids cannot be made with any accuracy because it is different at every dose. Since bupe is a partial agonist it is in a category all its own and is very different than the full agonists.

It is very misleading for people to talk about the 20-50 times thing without a full explanation.

Sheryl here’s the explanation is the proper context:

"…At analgesic doses, buprenorphine is 20–50 times more potent than morphine. Because of its low intrinsic activity at the mu receptor, however, at increasing doses, unlike a full opioid agonist, the agonist effects of buprenorphine reach a maximum and do not continue to increase linearly with increasing doses of the drug—the ceiling effect. One consequence of the ceiling effect is that an overdose of buprenorphine is less likely to cause fatal respiratory depression than is an overdose of a full mu opioid agonist.

Its partial agonist effects imbue buprenorphine with several clinically desirable pharmacological properties: lower abuse potential, lower level of physical dependence (less withdrawal discomfort), a ceiling effect at higher doses, and greater safety in overdose compared with opioid full agonists…

(http://naabt.org/links/TIP_40_PDF.pdf page 6, last two paragraphs)

S-

--added in edit--
How potent it is at low doses is completely irrelevant to how hard it is to discontinue. That is determined by the amount of physical dependence one develops to an opioid. It has been PROVEN that people develop LESS physical dependence to bupe, making it easier to discontinue than full agonist opioids. This is why it was developed.
S-
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Unread 07-27-2008, 09:05 AM   #3
Madison7
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Thanks for an excellent explanation!
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