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And finally, it is a bad idea to continually dose the ambulatory surgery patient with pure opioids per standard surgical orders immediately post-op if they were on buprenorphine, because pure opioids will not make it to the mu-1 receptors.Upon hospital discharge, AOT may finally get to the receptors when the patient is home and unsuspecting.Also, tell us if you’ve seen disasters because of the issues outlined above.

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Even the manufacturer (Reckitt Benckiser) admits to this, as seen in a 2004 Johns Hopkins University School of Medicine writing entitled “Practical Considerations for the Clinical Use of Buprenorphine“.

How then did Reckitt Benckiser ever convince the FDA that this is a necessary or safer combination compared to buprenorphine alone? Jones shares a diagram that is ironically referenced to the eminent Suboxone manufacturer, Reckitt Benckiser.

A chemical that forms a tighter bond can push one with a weaker bond off the receptors and take its place.

Thus, buprenorphine can push heroin off the receptors, and in doing so replace heroin’s full receptor stimulation with its own partial stimulation.

Here’s the figure from Jones’ writing with italicized dialogue from his article.