Injecting Buprenorphine (Suboxone, Subutex)

aaaaaainjecting

I know why addicts inject buprenorphine (Subutex): they think it saves them money. Over the long run, however, I doubt that’s true, given the hidden costs of addiction.

Buprenorphine has a relatively low bioavailability, at around 30%, when taken sublingually (under the tongue). This means only 30% of the total dose reaches the blood stream. If the pH of the mouth is lowered, bioavailability is reduced even further. This is why we recommend patients on buprenorphine avoid eating or drinking anything acidic for about twenty minutes prior to taking their dose.

By definition, when a drug in injected, it has 100% bioavailability. Therefore, some people inject their prescribed buprenorphine in order to get the desired blood level with a lower dose of buprenorphine. If they are prescribed 8mg per day, perhaps they use 4mg intravenously and sell the rest of their dose, or stockpile it.

People who misuse buprenorphine in this way may be blinded by their addiction to the multiple dangers of injecting drugs.

Anytime humans inject drugs into their bodies that weren’t meant to be injected, problems will occur. All sorts of medical complications can arise, which can cause exorbitant medical bills for drug users…and tax payers.

Skin: These pills weren’t meant to be injected, so they are not sterile. Buprenorphine does come in a sterile ampule to be used intravenously in healthcare settings, but I doubt that form would be found on the street for sale. The sublingual pills and film have bacteria in them, and we all have bacteria on our skin. Inevitably, some bacteria “go along for the ride” when pill matter is injected. This can cause skin and soft tissue infection of varying severity. Patients who inject can get anything from a mild cellulitis, which is an infection of the skin and soft tissues underneath, to life-threatening sepsis, which is a blood infection from bacteria. Many patients get abscesses, which are localized pockets of pus which must be drained in order to resolve.

The worst skin infection is called necrotizing fasciitis, which is a rapidly progressive infection that kills tissue. It’s also known as “flesh eating” bacteria. Often, surgeons have to remove whole infected areas of this dead tissue in order to save the patient’s life.

Scars and track marks are probably the most common skin manifestation of intravenous drug use. These can be minimized by also using a new needle, and not re-using needles.

As an aside, please don’t try to treat your own skin infections by yourself. I’ve seen horrible complications when patients try to drain abscesses on their own. And that leftover antibiotic you have on the shelf at home may not be a good choice to treat skin infections, particularly not the newer resistant bacteria.

Cardiovascular system: The tablets aren’t pure buprenorphine. The manufacturer’s website lists corn starch as another main ingredient. I don’t know for sure what that does to veins, but I know I use it in the kitchen to thicken a concoction if it’s too liquid. I imagine it does the same thing to blood in the veins. Even if the addict uses something to filter what he is injecting, some particles can still get through to the veins. Risks can be minimized by using a micron filter.

Again, bacteria can cause problems in the cardiovascular system. Sepsis, an overwhelming blood infection, can lead to endocarditis. This is a serious and life-threatening infection of heart valves. If the infection destroys a heart valve, heart surgery with valve replacement may be necessary.

Thrombophlebitis is a condition where the veins become clotting and possibly infected, usually at the injection site but sometimes further “downstream” in the vein. If this occurs in the deep veins pieces can break off and go to the lungs, causing pulmonary emboli.

If a drug is accidently injected into an artery instead of a vein, catastrophic complications can occur, including loss of limb below the level of injection. The artery becomes damaged which causes inflammation and clotting. The patient usually feels intense pain and burning immediately after injecting. Some sources suggest this can be treated with elevation of the limb and blood thinners, so go to your local emergency room if this happens to you.

Pulmonary: Corn starch and other particles like talc can cause clots and inflammation, creating structures called granulomata. As more granulomata are created, oxygen exchange in the lungs becomes more difficult, causing low oxygen levels in the patient.

Pulmonary emboli are clots from the venous blood system that break off and travel to the pulmonary arteries. When these clots are large enough, they can kill rapidly. The patient may have sharp chest pain, feel short of breath, and have a fast heart rate with low blood pressure. Blood can’t travel through the lungs to get oxygen, and the patient dies from lack of oxygenated blood. Even small clots can cause serious problems, particularly if they are also infected with bacteria.

This list isn’t complete – many other medical problems occur with intravenous drug use. Of course the most common may be transmission of the Hepatitis C or B viruses if needle/syringes/injection works are shared, as well as HIV. There are weird things like endophthalmitis, and infection of the internal eye, and other medical problems too numerous to list.

Opioid addicts using intravenously can get addicted to the process of injection. The brain repeatedly associates the ritual of injection with a rush of pleasure, and so the whole act of injecting can be difficult to stop. I’ve had patients on methadone and buprenorphine who continue to inject saline with no drugs just to feel the rush from using a needle. This can be overcome with time and counseling, but some patients have enormous difficulty with this.

So if you are reading this and considering injecting your buprenorphine in order to save money, please don’t do it. You will likely end up paying much more in the long run, and I don’t necessarily mean in a financial sense.

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8 responses to this post.

  1. First, thank you very much for the information. I had not considered shooting up my prescription. Even though I had been curious from people I have heard done so with the subutex type formula. I admit I tried it once, but apparently I was not good at it, as I did not succeed at getting a rush out of it. So good thing I failed.

    The time, a long time ago where I tried methadone, I did get some unpleasent effect. If I recall correctly a sort of a locked yaw, and “an attack of the stretching”.

    Nevertheless, a not sure I would try anymore any way.

    Thank you for the warning, apparently some people are trying it more than I thought and is good for the warning.

    I suppose there something’s that pharmaceutical companies are trying their best to keep people from doing those sort of “bad habits” but I can’t help it wonder whether they are trying to hard to keep people from doing it, that they might be creating formulas that would cause permanent damage. When some other formulas can be use that not may cause those damages. If one day we may discover that those formulas are done with intention to harm when a more safe formula can be done on those people that choose to do it, not only are they acting with questionable ethical practices, but they maybe risking a legal suite.

    I never heard you mention to avoid some damage infection that those people who still choose to do it to at the very least clean their skin with alcohol that is usual practices of any nurse or safe injector would do. I don’t want to create any panasea that this would solve all those problems, but would solve some if even just a few.

    It is unfortunately that what most people would miss out of shooting good heroine (even pharmaceutical one) isbbringing “the rush” and that is what pharmaceutical, researchers, governments and clinicians wants to take away.

    No matter what the most poetically correct opinion maybe, I take the most appropriate way to reduse harm. Even when patients become a lot more clever than those other institutions who are trying to keep drug users not necessarily those with bad habits, to president their happiness even when clinicians think they know what is better for the patients.

    Am not longer naive not to realize that clinical work and even science is not always honest and frequently gets politicize. Too bad, because I know that science and evidence based treatment can be honest.

    And I realized that clinicians can get real stupidity when they try to “adapt” without one iota of testing and way too much wishful thinking mix the pseudoscience of the twelve step as if it was treatment when in fact it is religious indoctrination. Let me remind you that neither Bill Wilson nor Bob where researchers. Dr. Bob was at best a proctologo, neither was Carl Jung (who is wrongly identified as a scientist)0, nor any of the doctors mention in the Big Book. Even after they got themselves sober they took them years before they were able to gain their first apostle. Even when the twelve steps where first implemented not one study of safety or effectiveness was ever done. Although now promoters of the twelve steps are coming out of the wood work making all kinds of claims of studies that are of questioable design.

    But substance use treatment is not the only branch inbtrouble when the field of psychiatry diagnosis are unreliable and invalid at best and fraudulent practices at worse. No other fields of medicine that I know of has 396 diagnosis to deal with and I am a proponent of taking the words “Statistical” out of this psychiatric “manual”. For too many years the APA has undeservedly had the monopoly of fooling the public and themselves into believing the DSM system had anything to do with science. When they are the biggest froud in medicine and deserve to be taken to legal trial for lieing to the public for too long and braking the public trust.

    Too bad, becsuse there are people who needs help, and they have fool the public at the expense of patients and manufacturing disease for which there is no scientific evidence. THEY DESERVE ALL THE LOST OF CREDABILITY THEY HAVE NOW AND WILL BE QUESTIONED IN THE FUTURE.

    TOO BAD THEY HAVE MIXED SUBSTANCE USE DISORDER WITH IN PSYCHIATRY. WE BETTER LEARN TRUE NEUROSCIENCE REAL FAST. WE CAN’T FIND THE EGO, BUT THE BRAIN WAS IN OUR HEADS ALL THE TIME AND HAS TAKEN TOO LONG FOR THEM TO DISCOVER IT.

    Reply

  2. Posted by Alan Wartenberg MD on November 2, 2015 at 3:15 pm

    While the nomenclature for substance use disorders found its way into Psychiatry, in fact the majority of members of the American Society of Addiction Medicine (two thirds or so) are NOT psychiatrists, so it isn’t exactly “mixed in” with Psychiatry. Many internists and family doctors (like me and Dr. Jana) work in the field, and have a strong background in the neurobiology necessary (as do many psychiatrists). Oddly enough, a large number, perhaps a majority, of psychiatrists do not treat patients with addiction, and required training in substance use disorders is relatively recent in Psychiatry (and complied with in a rather spotty fashion).

    Another complication that hasn’t been much reported, but was seen in Europe where injecting buprenorphine was quite common, is a “mitochondrial disease.” particularly involving the liver, which can result in acute liver failure, which is usually fatal. I have seen one case with an attempted OD on 64 mg of suboxone taken IV in a patient with hep C, but the person survived.

    Reply

  3. i do not agree with ur very first paragraph but that was some usefull information. as i am a recovery addict i know that fellow addicts do not shoot suboxin to try and save money but simply because the are addicted to the needle…. the habit of preparing your drug of choice and its routine is half of the addiction…..you get addicted to the prick…the sight of the blood…..shooting and useing a needle is just as addicting as the drug….ive known users that shoot up water just to use a needle….sick i know but this is the ugly truth…the same goes for people that snort or smoke drugs. just wanted to say that. thanks.~staci

    Reply

    • Posted by Amber LeJeune on December 10, 2015 at 5:35 am

      I agree. I been shooting suboxon and subutex for 2 years. And I hate it.. I know it works safer and better under your tongue… But I agree with what u said.. I’m addicted to the rou teen of it all. Lately I’ve been doing at the least 5 shots a day, and I have VERY deep and VERY small veins. For the pass 3 days I’ve been going threw hell trying to hit a vein and when I do, the fucking needle is clogged with what looks like a blood clot. Its not good at all. I only had 2 spots I could hit. Rotating 2 spots didn’t last. I’m doing everything possible just to do a shot! My fingers and hands are hidden, all for a stupid shot that don’t even faze me. Its all in the fix!! I been praying for strength and guidance for a while now. If any of y’all can give me good positive advice on how to kick this shit for good… I been sick and tired of being sick and tired and being sick and tired, I’m a lil worried about how ima feel without it.. I love it.. But I also love Val.. My main man…and my 10 yr old son Landon. I can do it!!! I can do it!!!!!! I can do it!!!!

      Reply

  4. Posted by Donna on November 5, 2015 at 11:57 am

    I have a question that goes along the line of complications/adverse effects. I have been in recovery since May 21 , 2003. As a medical professional, I had access to injectable opiates for years until I didn’t. But I injected IM in the hip many many times. I have what I can only describe as hard knots underneath the skin now. They are about the size of a pea and not painful. Can you tell me what this us called and can you get rid of them? Thank you in advance.

    Reply

  5. Posted by Who on December 21, 2015 at 3:21 am

    The thing is in most rural areas in this day of age do not have access to doctors to get medication prescribed to them. I live in one of those states, WV is one of the hardest states to get proper addiction treatment. We have your regular methadone clinics that offer up the regular stuff. Suboxone doctors are in short supply though, and getting into one is damn near impossible. Waiting lists are 6 months to years long, I was on one for years before I got in only to find out I can’t have suboxone due to an allergy. I was lucky enough to find a doctor that would prescribe the mono product for a little while until government people wanted to put a halt to everything because they want too. This is the reason a lot of addicts will inject their pills in this area because you cannot get them and they try to make them “last” for a week. You can barely find them on the streets around here and I always hear about the local government talking about their on the street everywhere and thats a plain lie. What most of these doctors don’t realise or fail to acknowledge is Suboxone can be injected just as much as Buprenorphine Mono. If an addict around here is lucky enough to get into a doctor usually they can’t afford it more than a month because it is illegal to prescribe the mono product unless you have an allergy or you are a pregnant woman. It is insane that people with addiction can’t get help without forking over thousands of dollars to get it. Yes I understand it costs money to produce, the doctors have to get paid because that is their profession but as far as medical care goes the US has one of the worst systems. Addicts in prison can get help easier in the UK than US citizens can get in free society. It is insane that people that know nothing about treating any medical problems can dictate the treatments that are available. There are bad apples in every bunch but just because there is doesnt mean everyone is. It sucks patients can lose medications that they need to live just because some government official feels its right. If you are a millionaire though you can get any treatment any where, and probably for cheaper than the normal working class person because of social status alone.

    Reply

    • Posted by Derelicte on May 28, 2016 at 7:13 am

      Wow great post thanks.

      And to ‘Who’, I couldn’t agree with you more everything you wrote is correctemundo.

      Ciao

      Reply

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