Discussions that mention demerol

Pain Management board


The buprenorphine (bup) in the Norspan patch is what's referred to as an opioid partial agonist/antagonist. These narcotic pain meds work by attaching to "pain receptors" in our brains, spinal columns and peripheral tissues. Most of the more common narcotic pain meds are called "full agonists" like morphine, demerol, oxycodone, etc. Their potency depends upon how tightly they bind to the pain receptors, how well they saturate the pain receptors and how long they remain bound. A full agonist has no ceiling, meaning there's no upper limit to how much can be used, which is great news to those with intractible cancer pain.

A partial agonist, like bup does have a ceiling, beyond which there are very negative side effects. In addition bup has narcotic receptor antagonist properties as well, meaning when it binds to the receptor is blocks anything else from getting there. And, it binds so strongly to the receptor that anything else there at the time gets kicked out. This is why if one is dependent on a full agonist like morphine, and takes bup, they will go into immediate withdrawal.

What this means to you - you probably should NOT be trying to mix bup and opioid meds like codeine, morphine, etc. They should not work well together and may well cause you to feel the opposite of euphoria, which is dysphoria. My recommendation would be to stick with bup entirely if on Norspan, and use the sublingual bup for breakthrough pain. Then, if you go to the fentanyl duragesic patch, you need to completely avoid anything with bup in it or you'll be very sorry (terrible withdrawals).

steve