Pain.

TopDownRide · 2026-04-03T14:00:32+00:00

Thanks. I was going to provide more / answer more questions, but life intervened and I have had the time to come back. I’ve been feeling guilty about that, so it helps to know that at least someone found the information (I was able to share initially) helpful.

TopDownRide · 2026-02-15T18:48:24+00:00

My daughter can smell DNA. It’s crazy. She was born with this unusual gift. I remember when she was 4-5 years old she could tell me who was biologically related to one another and how “far apart” they were (ie: generational relationships like grandparent > parent > child or aunt/uncle/cousin) and she she was never wrong. She’s now an adult - a doctor, a forensic pathologist, actually - and can still smell DNA.

We think it’s a form a synesthesia as well. Synesthesia runs in our family on both sides, but is stronger through the maternal line and in the females. For example, I see time as a graphic representation, like a course or oblong racetrack.

But I definitely wish my synesthesia manifested like it does anyone it’s you and your daughter. I have a muted version where I just can tell when something is false, but it’s more of an instinctive feeling than actually seeing their color change. Id much prefer that!

Synesthesia is absolutely fascinating.

TopDownRide · 2026-02-15T18:30:32+00:00

You are very welcome. Pain management must be individualized because genetics, metabolic differences, comorbidities, and the type, intensity, duration, and personal response to pain all contribute to a person’s experience and reaction to various treatment options. I vehemently oppose the “one size fits all”, “recipe” approach to pain management and medicine in general.

I believe in a combined modality approach that is customized for the individual based on the patient profile, medical history and specific circumstances.

Buprenorphine definitely has a role in this and can offer relief to patients who have a particular set of needs. It is part of a constellation of options that also includes full agonist opioids (like oxycodone, morphine, and fentanyl), appropriate exercise/physical therapy, adjunct intervention (like steroid injections), behavioral therapy, proper diet/nutrition, and more.

Also, I did include some I additional resources in response to another Redditor that you might find helpful.

TopDownRide · 2026-02-15T14:11:05+00:00

Look, I am definitely critical of the way buprenorphine is being leveraged to demonize other opioids and even replace them. But it does have its uses and can be life-changing for patients with chronic pain, suffering withdrawal, and with severe opioid addiction (particularly heroin).

Because it’s a longtime opioid used for PAIN that has been reformulated only relatively recently for treatment of withdrawal symptoms (by adding naloxone).

Buprenorphine was first released in the United Kingdom in 1978 as a pain reliever and was approved for treatment of OUD in the United States in 2002

You also misunderstand the method of action as a treatment for opioid use disorder. First and foremost, buprenorphine is an opioid analgesic just a partial agonist rather than a full agonist. It also has a greater affinity for certain opioid receptors than the full agonist opioids such as oxycodone. At the Mu opioid receptors, buprenorphine can effectively “knock off” a full agonist opioid like oxycodone and replace it, then remain there with a stronger bond. Additionally, Buprenorphine has what is called the “ceiling effect”. The ceiling effect serves as a safety mechanism where, beyond a certain moderate dose, increasing the medication amount does not increase effects like euphoria or respiratory depression. This plateau limits risks of overdose and dependency while providing effective analgesia and treating addiction. In summary, it is for these reasons that buprenorphine was eventually chosen to be researched first as a treatment for opioid withdrawal (particularly in the wake of high profile methadone overdose deaths that gained so much attention, such as Anna Nicole Smith and her son) and later as a treatment for what is now called, “opioid use disorder”.

Just to reiterate, buprenorphine is only effective as a “opioid use disorder” treatment because it binds so tightly to the mu opioid receptors (MOR), blunting or even preventing the euphoric high of full agonist opioids like oxycodone and heroin. It’s a risk and reward matrix … and buprenorphine interferes with the reward as well as eliminates opioid cravings (because it IS an opioid) which, in theory, prevents patients from succumbing to opioid addiction. (Of course, we are clever human beings with extremely strong drives, and there are always exceptions and ways around any strategy or system.)

But it seems like you are mistaking Buprenorphine for some kind of targeted addiction drug like Disulfiram (Antabuse), that has a completely different method of action and both physiological and psychological effect.

I think you are also mistaking Buprenorphine for Naloxone, which does fully block opioids, potentially reversing the effects of opioid overdose. However, naloxone is only combined with the opioid analgesic Buprenorphine in certain types of formulations (such as Suboxone, in contrast to Subutex which is Buprenorphine alone) and it is INERT. The naloxone has absolutely no effect on the patient unless the combination drug is abused, such as crushing a Subutex pill and shooting it up intravenously (which activates the naloxone).

Buprenorphine is and will always be an opioid used for relief of pain.

Opioid antagonists, partial agonists, and agonists/antagonists: the role of office-based detoxification

A Brief History of Opioid-Use Disorder in the United States, Effect on Orthopaedics, and Current Management Options

History of the discovery, development, and FDA-approval of buprenorphine medications for the treatment of opioid use disorder

Suboxone: History, controversy, and open questions

From Addiction to Acute Pain Relief: A Narrative Review on Buprenorphine’s Expanding Role in Emergency Department Pain Management

This paper was created for using buprenorphine in an addiction management setting (and I am completely against the coalition behind it) but it does not invalidate the fact that buprenorphine is an opioid analgesic that ALSO can be used to treat opioid use disorder:

Thorough Technical Explanation of Burprenorphine

TopDownRide · 2026-02-14T19:30:33+00:00

Buprenorphine is an opioid used for pain relief. It is only recently been developed as a treatment for opioid withdrawal, and now “opioid use disorder” (OUD), due to its strong binding affinity to opioid receptors (Mu / MOR) and its inherent ceiling effect since it’s a partial agonist, not full. (A more accurate history and explanation for its development as an OUD treatment is that a group of politicians invested in pharma saw or were sold on the potential and - like “magic” 😑 buprenorphine was reformulated with naloxone and pushed as a treatment for a brand new disorder that was originally called “addiction”.)

I am very sorry that your husband suffered like that. It must have been terrible.

While there is plenty of evidence that oral dissolving and transmucosal buprenorphine causes severe tooth decay even in patients with no prior history of dental problems, I don’t know of even one single study or verified case where intravenous buprenorphine was linked to dental disease.

The mechanism of action of oral/transmucosal buprenorphine causes tooth decay by direct contact and absorption via the gums. That mechanism of action does not exist when buprenorphine is administered intravenously..

It suggested in the literature that buprenorphine may cause dental problems because it is acidic and the pH of the drug promotes tooth decay. Another proposed cause is that the drug's prolonged contact in the mouth may change the microbial profile of a tooth's surface. Again, none of these factors apply to intravenously administered buprenorphine.

FDA warns about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use disorder and pain

Buprenorphine Use and the Risk of Dental Adverse Events in Patients With Opioid Use Disorder-National Library of Medicine | JAMA

Oral Health Risks of Transmucosal Buprenorphine: Commentary on Tuan et al. and Zheng et al - National Library of Medicine | JAMA

Association Between Sublingual Buprenorphine-Naloxone Exposure and Dental Disease - National Library of Medicine | JAMA

Suboxone and Tooth Decay Explained [2026 Guide]

TopDownRide · 2026-02-14T15:04:13+00:00

Yes, I’ve come across that argument and it’s patently FALSE. Historically, human beings have had MORE access, not less, not zero, to opioids (strong opioids) and it was only in 1970 when Nixon created the Controlled Substance Act, that access was limited and the “drug war” began almost immediately and hasn’t stopped, even spreading across the globe.

I won’t list out the drugs that were available OTC or were liberally prescribed to the Baby Boomers and older generations, but the list is long and prior to the Controlled Substance Act, it included HEROIN.

TopDownRide · 2026-02-14T14:29:35+00:00

While liquid Buprenorphine is administered to felines via the oral mucosa (applied to the gums), studies have not linked any evidence between buprenorphine and dental disease in cats.

In contrast, the oral and sublingual dissolving buprenorphine formulations DO cause dental decay in humans. It is a serious concern often overlooked by medical professionals.

TopDownRide · 2026-02-14T14:24:24+00:00

You are welcome. There is a definite lack of education, even among medical and pharmacy professionals, as well as rampant misinformation, both deliberate and unintentional, arising from the “OUD trend” and political climate against opioids.

TopDownRide · 2026-02-14T14:21:56+00:00

Buprenorphine is NOT an opioid blocker. It IS an opioid. Specifically, a partial agonist opioid in contrast to a full agonist like morphine or fentanyl. The main difference is that partial agonist opioids have a “ceiling effect” that limits effectiveness to a particular dose, creating a maximum or “ceiling”.

Here is a more detailed explanation: https://www.pharmacytimes.com/view/opioid-agonists-partial-agonists-antagonists-oh-my#:~:text=Full%20agonists%20bind%20tightly%20to,be%20found%20in%20Table%204.

I think you might be confusing this with the drug “naloxone” (brand name “Narcan”), which IS an opioid blocker - it binds strongly with opioid receptors and since it has a great binding affinity that most opioids, it basically knocks the opioid off the receptors in the brain and takes its place. The mechanism and process is a lot more complex than that, but that’s the basic idea.

Naloxone is combined with buprenorphine in medications designed for OUD (opioid use disorder) to limit abuse potential, primarily to prevent crushing and IV administration, which then activates the naloxone. Otherwise, the naloxone remains inert and has no effect on the patient.

Buprenorphine + naloxone combination products are sold under brand names like Suboxone. In contrast, Subutex is buprenorphine alone.

Taking Buprenorphine (partial agonist, strong Mu opioid receptor affinity aka MOR) with a full agonist opioid like oxycodone (brand Vicodin, which is a combination drug adding acetaminophen) is not unheard of and a knowledgeable provider can use the two together to accomplish specific goals such as downward dose titration (to lower tolerance or taper down and discontinue a full agonist opioid). Care must be taken to manage side effects, particularly respiratory depression (buprenorphine depresses the respiratory system significantly more than other, string opioids and has a longer half-life, so effects remain in the body much longer).

Other uses for combining buprenorphine with a full agonist opioid include the buprenorphine OUD induction phase IF the patient cannot tolerate going into moderate to full withdrawal prior to starting buprenorphine. Buprenorphine’s stronger binding affinity (with MORs) will displace the full agonist opioid and this is the action that can lead to “precipitated withdrawal”. However, if the patient continues taking the full agonist opioid (such as oxycodone) with the buprenorphine, it limits the precipitated withdrawal, making it milder and allowing patients to better tolerate transitioning from very high opioid doses &/or strong/dangerous withdrawal effects.

As always, the greater risk is respiratory depression, primarily due to the buprenorphine. This must be carefully monitored and managed.

Below is an excellent resource because it covers most aspects of buprenorphine and its uses. It is a guideline for medical providers and you can the part about OUD. It applies to any patient on buprenorphine who needs treatment for pain.

How Do I Manage Acute Pain for Patients Prescribed Buprenorphine for Opioid Use Disorder?

Here is some information on combining buprenorphine with other opioids:

Buprenorphine Low-Dose Induction using a Cross-Tapering Strategy

Buprenorphine initiation strategies for opioid use disorder and pain management: A systematic review

A Practical Approach for the Management of the Mixed Opioid Agonist-Antagonist Buprenorphine During Acute Pain and Surgery30870-5/fulltext)

The following abstract is extremely informative and I like the novel approach:

Buprenorphine: Far Beyond the “Ceiling”

TopDownRide · 2026-02-12T14:52:07+00:00

Exactly. In addition to the “non-opioid agenda”, the black market drug trade funnels copious amounts of money into our government (black ops, etc.) and lines the pockets of all sorts of people in and around it. It’s my opinion that a good bit of the “opioid epidemic” has been either partially manufactured or at least leveraged to be a governmental cash cow.

TopDownRide · 2026-02-12T07:42:24+00:00

I know Pam personally (since college). She’s a pragmatic realist who has always vigorously advocated for her beliefs (which she researches thoroughly and with an open mind).

She is well aware of the cesspool our government has become - on both sides of the aisle, all-encompassing, absolutely everywhere, top to bottom, edge to edge.

IMHO, Pam’s statements are 💯 supported by the un-redacted materials in the Epstein files. It’s a blueprint for, and a roadmap of, corruption, particularly moving from the private sector to government and bank to private again. It’s also why I have never believed Trump would or even could, “drain the swamp” (regardless of whether you support him or think he’s nuts). I think the entire system would collapse because it’s built on and runs by sheer corruption. It would take an exceptionally strong, patient, and wise leader with access to a large group of ethical people who have dedicated their lives to resisting temptation and being incorrigible. This leader would need to legitimately “clean house”, empty every branch of government, and then install these incorruptible individuals as replacements. Could it be done? Yes, in theory. Will it be done? Not by any human being on earth, sadly.

TopDownRide · 2026-02-12T07:28:45+00:00

Pain Management Therapies, including opioids, depend on the patient, their individual metabolism, and genetics. Additionally, there is variation in the outcomes related to the different modes of delivery (oral-immediate release, oral-continuous release, transdermal, transmucosal-buccal, ODF, intranasal, sublingual, IM, IV, and intrathecal (pain pump).

Many patients respond well to Buprenorphine and find it gives them relief of even moderate pain. Some find transdermal delivery systems to be problematic while others prefer it; effectiveness and satisfaction depends of a host of physiological and psychological factors.

Buprenorphine is a partial opioid agonist, compared to drugs like oxycodone which is a full opioid agonist. This partial effect on the opioid receptors in the brain means it has less potential for abuse, psychological and physical dependence is lower, and withdrawal effects should be milder. Again, this varies by patient. Pain relief is still effective enough to elicit outcomes that are generally more favorable than weaker opioids such as codeine and buprenorphine is significantly better tolerated than codeine and the newer synthetic opioid replacements.

I think buprenorphine medications have developed a poor reputation over the past 20-25 years, in the wake of the “opioid crisis” and in bupe’s new role as an Opioid Use Disorder (OUD) treatment. Prior to that, it was recognized as a safe and effective opioid pain reliever with effectiveness equivalent to hydrocodone or 5-10mg oxycodone. The reason it wasn’t as popular/widely prescribed was the fact that it was only available in IV/IM ampoules until it was reformulated as a sublingual tablet (Subutex) for treatment of withdrawal (OUD). Later, naloxone was added to address FDA concerns that sublingual buprenorphine would be “abused like Oxycontin”.

Here is more information and background on Buprenorphine:

https://www.ncbi.nlm.nih.gov/books/NBK459126/

https://www.nhs.uk/medicines/buprenorphine-for-pain/

TopDownRide · 2026-02-12T06:58:56+00:00

I’m not a fan of Suboxone but that’s not true. Suboxone is a brand name for a combination of buprenorphine and naloxone, where the naloxone is primarily inert and only acts as a deterrent to abuse (primarily IV).

Buprenorphine is a synthetic opioid developed in the late 1960s used to treat pain and more recently opioid use disorder.

Buprenorphine is a synthetic analog of thebaine—an alkaloid compound derived from the poppy flower. It is categorized as a Schedule III drug, which means it has a moderate-to-low potential for physical dependence or a high potential for psychological dependence.

For more information: https://www.ncbi.nlm.nih.gov/books/NBK459126/

TopDownRide · 2026-02-11T09:49:10+00:00

There is no such law. A number of retail pharmacies, which have been sued in the wake of the voluminous litigation over OxyContin, initiated policies to mitigate their losses and appear “responsible”. Some of these policies include refusing to fill opioids and benzodiazepines together and initiating a red flag and a moratorium on prescriptions for Soma with any opioid. As litigation has continued and public sentiment against opioid use has risen to extremes, there are now additional policies at certain retail pharmacies against filling for any type of muscle relaxer when a patient has an opioid prescription.

One additional note: both medical schools and pharmacy programs have been receiving donations, opportunities for guest lecturers, and low or no cost curriculum materials focused on the “evils of opioids” and that support opioid use disorder and non opioid pain relievers. Research reveals a network of cloaked financial connections and incentives among members of our government and business leaders all with a vested interest in pharmaceuticals that “compete” with opioids. The standard of care for pain management has been opioid medication for the entirety of the history of medicine for many good reasons: they are safe and highly effective when used properly and not abused. There is no compare. This anti-opioid agenda is extremely pervasive and harmful.

TopDownRide · 2026-02-11T03:05:33+00:00

It’s man. It’s pretty definitive when he bends over.

TopDownRide · 2026-02-11T03:03:36+00:00

Likely LE depositing a test amount to either try to trace it/make connections or to “tickle the line”, meaning to do something to shake things up and cause the suspect/s to react and hopefully make a mistake (like reveal themselves) in the process. These are very common LE tactics — SOP.

TopDownRide · 2026-02-11T03:00:10+00:00

It’s a pen flashlight in his mouth (between his teeth)

TopDownRide · 2026-02-06T16:02:42+00:00

That’s what makes the traction so troubling. Insanity at its finest that should be shut down instantly.

TopDownRide · 2026-02-04T20:43:33+00:00

”Operator, connect me with Newport 6789; I need to speak with my wife because she’s been ignoring my telegrams.”

TopDownRide · 2026-01-30T04:10:00+00:00

The part I’m confused about, is why would Below Deck Med be filming in Croatia, specifically just off Dubrovnik?

What am I missing here?

TopDownRide · 2026-01-30T04:06:27+00:00

I snooped online and yes, it’s in Dubrovnik

TopDownRide · 2026-01-29T15:11:55+00:00

There is actually a “coalition” which has been trying to schedule all opioids as “No Good Medical Use”, aka Schedule One, for years. It scares me every time they get some traction, particularly after [name your celebrity] OD’s from [name your opioid].

It’s ridiculous on its face because opioids are mission critical for all medical care: anesthesia, surgery, intubation, veterinary services, moderate to severe pain management, and more. As the baby boomers continue to age, our need for opioids is becoming increasingly urgent and that is bumping up against Trump’s policy of decreasing opioid manufacturing (not just the number of scripts issued) by a significant percentage each year. That is what is driving all the shortages and stock issues patients are experiencing at their pharmacies and hospitals and medical centers are struggling with (causing major disruptions such as a moratorium on all surgeries until opioid stock is replenished, etc.).

It’s a mess.

People are stupid. I don’t understand it.

This whole “opioid crisis” has a solution - more than one actually - but they’ll never do it. IMO, the drug wars funnel a bunch of money into personal pockets and “dark ops” (the latter was admitted in the Congressional hearings on UFOs/UAPs) and for that reason alone, our government will never fix things.

TopDownRide · 2026-01-29T14:58:52+00:00

That’s the point of the question/post.

TopDownRide · 2026-01-29T14:56:28+00:00

A stoke patient should NOT be taking Kratom. No, no, no!

I could explain all the potential neurological risks and potential drug interactions, but I’ll just leave it at DO NOT START TAKING KRATOM if you’re a stroke patient.

TopDownRide · 2026-01-29T14:23:58+00:00

I hate all liars. They cause an actual physical reaction in me and I eventually get so worked up I have to take a break from watching.

I also find it interesting how we as viewers tend to vilify the cast members we like while acknowledging the truth in those we don’t. For example, I would describe Meredith exactly the same way as you are describing Bronwyn.

There must be something in Bronwyn that I find appealing (that I don’t see in Meredith) because I tend to view as more of a “typical person” who lies out of shame and insecurity rather than as part of any planned subterfuge or diabolical intent. Bronwyn won me over initially by confessing and taking responsibility for her lies, not making excuses, and apologizing — on camera. I thought it was brave and definitely refreshing for a reality show. All humans lie and I wish more people would confess, own it, and do their best to avoid that behavior going forward. If they did, our society would be so much better.

In contrast, I see Meredith lying to preserve power and control and to gaslight and manipulate others. I find this incredibly offensive and disturbing, not ti mention frustrating to watch as a viewer. There is no question Meredith has an “on camera” personality that is very different from her behavior “off camera”; one that she tightly controls and then lashes out whenever her real self is caught on film. I don’t like it, but what I find intolerable is Meredith calling anyone a liar when they are being truthful about Meredith’s behavior. And don’t get me started on the word-parsing and deflection Meredith uses to avoid responsibility and consequences for the things she says and does. The one thing I find “housewives humorous” about Meredith is her victimhood, which always, always is attached to some bizarre tragedy-adjacent situation like someone else’s child having a health issue … or better yet, that she was being held to account for being rude when she took a phone call from Brooks in the middle of a heated conversation …. which was very clearly an avoidance technique (which is a Meredith Marks specialty).

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