BUPRENORPHINE/BENZODIAZEPINE INTERACTIONS (OR LACK THEREOF)

[cant_overdose]

I take xanax and bupe every day. 16mg of bupe, which I still do enjoy the effect of, even 7 years later. So I totally don't agree with the almost consensus that it has no recreational value. Though I suppose its different for everyone.

Also xanax around 6mg or so, I'm working on getting that down. Used to be 8mg. I'll admit taking both of these two, plus all my vaping can leave me somewhat short of breath at times but I haven't died yet.

I've pretty much resigned myself to taking bupe for the rest of my life but I'm still pretty scared of lifelong benzo addiction... and do want to get off..... and you should too. It doesn't lead to anything good. Especially xanax of all benzos. Maybe your doc would be more relaxed with something like diazepam.

But geeze if you are that dead set on getting more xanax just buy some online. I bought a bag of 1000 bars like 3 years ago and still have plenty left. Probably didn't cost me much more than a few of your doctor appointments.

Actually, I've been doing a lot of thinking about what Keif', you, and others have said. The truth is I generally don't manage things like this responsibly. Although I have gotten way better about it. I don't need a xanax addiction in my life. Currently, I give them to a family member to hold and dispense, so asking for more than the prescribed dose is a hassle that's not worth it usually. I too, expect to stay on bupe, but as I said I get no opiate-like sensation. It's all about blocking other opiates so they're no longer a concern at all.
Sure buying it online would be idea, I mean I have a prescription so it would maybe be technically legal. But I wouldn't know where to buy it online. They all seem like scams to me. Plus I'd be afraid of catching a trafficking charge.

 

[cant_overdose]

Schizoaffective disorder, if my understanding is correct, is described as lying somewhere between schizophrenia and depression or bipolar disorder.

Now it has long been known that opioids are somewhat effective in treating schizophrenia and indeed was sometimes prescribed before the neuroleptics were discovered. So were you using opioids as a form of self-medication?

Buprenorphine has been shown effective in treating schizophrenia:

Antipsychotic effect of buprenorphine in schizophrenia - PubMed

The antipsychotic potency of the partial opiate agonist buprenorphine was evaluated in 10 neuroleptic-free schizophrenic patients suffering from frequent hallucinations, delusions, and severe formal thought disorders. Buprenorphine had a pronounced antipsychotic effect, which lasted about 4...

pubmed.ncbi.nlm.nih.gov

Now aplrazolam is used to treat anxiety and as I previously stated, long-term conditions such as GAD and unipolar depression and although it has been shown to promote mania in certain cases, it has been trialled in the treatment of certain forms of bipolar disorder:

Alprazolam for depression

The 'off‐label' effect of alprazolam on depression has not been systematically evaluated.To determine the antidepressant effect, including tolerability and acceptability, of alprazolam as monotherapy for major depression, when compared to placebo ...

www.ncbi.nlm.nih.gov

Alprazolam in bipolar-I depressions - PubMed

In an open-label study of alprazolam in five bipolar-I depressed patients, three patients remitted completely, one failed to respond, and one responded transiently, based on the Hamilton Rating Scale and Beck Depression Inventory scores. Further studies of alprazolam as an antidepressant are...

pubmed.ncbi.nlm.nih.gov

If that's the case, I can see the reasoning behind the doctor's choice. The neuroleptics can cause terrible side-effects and so this sounds much more like an attempt not to make any depressive symptoms worse.

I could not find any more robust data but I think it perfectly reasonable to ask the doctor about this. Treatment generally works better if doctor and patient are on the same page. But generally, doctors don't like explaining too much. I don't quite know why.

But as a bipolar disorder sufferer, I would tell the doctor if you are or were using stimulants as self-medication for depression. I suspect your doctor might have guessed because generally speaking, if you are caught using street drugs, obviously they will be concerned that you might misuse your prescribed medication.

If the alprazolam is prescribed to treat depression, an effective dose is surely required. Other benzodiazepines have been used to treat depression but only the US still uses one; specifically alprazolam.

If the higher dose of alprazolam means you don't need the modafinil then it may be a useful tool in discussion. After all, it's one less drug and so one less possible interaction. Frankly, any more than two different medications and NOBODY understands the interactions. It might alter the metabolism of the other medications increasing or decreasing plasma concentrations and clearance times.

But I just take the oxycontin I am prescribed as directed by my doctor to manage chronic pain and clobazam as prescribed to treat myoclonus. I totally avoid all other drugs and alcohol as well. I was given a neuroleptic but I was simply asleep for most of the time and groggy when awake. So I stopped after a week. I manage the bipolar myself which means having a routine, avoiding stressors (where possible) and trying to remain positive. I know, it's easier said than done BUT I received proper counselling which had enormous value.

You mentioned auditory hallucinations. Is that your own description or one applied to your condition? Because it's a very vague term and I am lead to believe that with schizophrenia, voices that are experienced which is disturbing enough but sometimes voices that are malign which I imagine must be dreadful.

I hope this of some help.

An informative and insightful post as always, AlsoTapered. It's cool you couldn't find any sources, I really appreciate all the effort anyway. And yes, the alprazolam is the closest thing to an effective mitigator of depression than anything I've ever taken. Except maybe the street drugs, which I no longer do.
I saw my doctor yesterday, and decided not to ask for an increased xanax dose. I'm taking Keif's advice to just be happy I'm that he trusts me with these meds, and learn to moderate my use. But a funny thing happened. I got paperwork in the mail from my insurance company from out of nowhere saying that they wouldn't cover the modafinil (since it's an off-label use) until I had taken adderall and then ritalin and both had failed. It's funny because I was on adderall when I first started seeing him and asked to switch to modafinil I was having trouble overtaking the adderall, then running out way too soon & wanting to use meth again (I didn't tell him all that). Now, the insurance co. sent both him and me paperwork to the effect that he had to put me back on adderall, and then after that, they will cover the modafinil. Which is great; I've been paying for it personally for years.
I won't lie, I was a little elated by the idea of being on amphetamine again. BUT, I don't know if it's due to the adderall shortage in the US or what, but these pills...they aren't right. They don't have the effect they're supposed to. They're the pink ones by Epic pharma, and they're just trash. It's as if the company just said "Fuck it" and threw in some shit scraped off the lab floor. A bunch of by-products. It doesn't help you focus, it spaces you out & makes concentration more difficult. I'd have taken them back if I could.
I think you're right in your schizoaffective description, that's pretty much what I got when they diagnosed me & I read about it. And yes I've told my other doctor, a psychiatrist, about the hallucinations. It's a weird thing but they're rare & usually seem to happen when I'm afraid, so I think dopamine is involved (does that sound right to you?). At night it happens more often, like randomly. When it does I'm 100% certain it's real, and yeah it's terrifying. Only later do I realize it didn't even happen.
I read about myoclonis, seems to be a symptom of anxiety? Is that right?
Yes, I think my use of opiates was self-medication. But I think that's probably true of almost anyone with substance abuse issues. For someone to see a heroin needle or meth pipe, and to know all that we associate with that - diseases, addiction, ruined lives, overdose, death, jail & prison - and to think, "Hm, that might be just what I need" I think there must be some kind of underlying mental health problem to begin with.

 

[cant_overdose]

Everything I'm writing comes from a position of acceptance. I mean accepting that I ultimately can't control the end-result whenever I consume certain (most) drugs. Whatever I do, whatever happens, I ultimately will not be in control of my life or the situation.

Along with just the "doing hard work" bit when trying to get clean, there are some things that really helped me. I didn't put myself in situations in which I was likely to be exposed to drugs. I deleted phone numbers etc. None of these things are fool-proof. There was an instance 2 years into my clean-journey when the only thing that stopped me was that I no longer had this person's number. Of course I could get the number, I could go downtown and score, all that stuff. The thing is, every layer of security between myself and drugs is helpful.

When I say "gate keepers" I just mean I don't believe in automatic, unlimited, as much as you can carry drug prescribing. I believe in giving them what they want/need. I think it adds an extra layer of security to the stability of users. They know they can only go once/twice per day and that's it. They know any dope they could score would not compare in quality. With all of these considerations, the addict hopefully forgets the craving and continues treatment.

I've been in situations in my life where I had unlimited quantities of Morphine/Heroin. I always assumed that would be the best thing ever. When I was using 5g a day I just fel completely numb, emotionally, physically all of it. It wasn't fun or enjoyable. The only way I got my perceived benefits back from Morphine was by lowering the dose to no more than 2g Heroin at most. This is still a lot, I know.

If we're talking about peoples' long-term success, I think it would be good, at least in the beginning of treatment, to monitor and dispense the drugs carefully. Too little will lead to relapse, too much leads to the symptoms described above. There seems to be a goldilocks zone and it seems to be under 2g per day. After that, I just get more side-effects than anything.

I just think it would be really great to have someone work closely with the patient and balance the cravings and urge to use with their actual goals in life. In short, I just think there needs to be documentation. I believe Buprenorphine exploded due to people adjusting their own dosages to unnecessarily high levels. I don't want to see a similar situation occur with newly-legalized drugs.

You're right of course. Perhaps society could decriminalize use of all drugs, but the schedule III and below would require counseling and limit access to a reasonable amount. I bet the majority of users would accept that compromise, stay within the confines of the law, and learn to moderate their use rather than resort to blackmarket, illicit sources. I know I would.

 

[AlsoTapered]

You are quite right that myoclonus can be triggered by stress. Long term lack of sleep and/or low-quality sleep being the direct cause. But it's when the stressors are removed and the myoclonus continues that you know you are pretty much stuck with benzos for life.

I went out of my way to get clobazam rather than clonazepam. It's longer-acting and isn't associated with a 50% increase in the likelihood of developing Alzheimer's in later life. Sadly it's dose-response curve plateaus are about 40mg/day and it would appear that the therapeutic window closes i.e. taking more won't DO more.

After a couple of decades on clobazam, I might have to throw in the towel and accept that I will have to switch to clonazepam. BUT that's a couple of decades of NOT taking it, so worthwhile, I feel.

If your psychotic symptoms are mediated by specific emotional triggers, medication might not be the best option. Appropriate counselling really can help a lot. Of course, I'm in the UK so my treatment isn't based on what an insurance company will cover.

It is truly madness to lock someone up because they take a specific chemical. If YOU are supposed to be the victim, why prison? Why not medical treatment? Simply because prison is cheaper and catching users is often easier than catching dealers.

Personally I've only ever taken prescription medicines and compounds whose source I KNOW i.e. I tried TMA-2 because a friend made it. I tried LSD because a friend made it. And so on. I tried MXE before it had a name... because (all together) a friend made it.

I've read too many NMR/GC-MS analyses to ever trust a street drug. It's not occasionally impure, it's almost always impure and who knows what the impurities do? It's fear that stopped me, not the law.

 

[Pickledlemons]

You're right of course. Perhaps society could decriminalize use of all drugs, but the schedule III and below would require counseling and limit access to a reasonable amount. I bet the majority of users would accept that compromise, stay within the confines of the law, and learn to moderate their use rather than resort to blackmarket, illicit sources. I know I would.

I don't know about everybody accepting moderation. But I think the state would be better off with the profits of our addictions rather than people that dabble in human trafficking. Decriminalization is better than nothing, but full legality is the way to go, I think. Its the laws that targeted oxy and heroin that lead to the absolute garbage dope you find on the street these days and the overdose epidemic and nasty effects of xylazine. Almost makes fentanyl now seem like the lesser of two evils. Hard handed drug policy always backfires and makes life harder for people.

 

[AlsoTapered]

It's Grisham's law in action. If SOME people will accept fentanyl then it's competing with heroin. Since the profitability of fentanyl is vastly higher than that of heroin, the fentanyl producer can simply undercut the heroin producer until people are forced to accept a way worse and way more dangerous product.

The nitazines were introduced because it became cheaper (due to controls on Chinese precursors for fentanyl production) BUT when things like carfentanil arrive, the scale need only be 1% that of fentanyl to produce the same number of doses and controlling 100g sales of quite common chemicals is tricky.

Once controls are placed on the nitazine analogues, BDPC analogues (specifically MDPC analogues) will turn up. There will always be another highly potent opioid to take the place of one whose production costs have been driven up.

Even naloxone is just 2 steps from oxymorphone or an N-arylethyl derivative that will be hundreds of times more potent than Morphine.

Every time a drug is controlled, a worse one shows up.

 

[SpiralusSancti]

Every time a drug is controlled, a worse one shows up.

That mostly seems to be the case but since drugs in terms of TI and recreational value don’t strictly follow any kind of trends when it comes to their profitability I think in such a volatile market as USA opiod scene became (and some source countries are) I think it’s reasonable to expect rather safe and good stuff too will appear at some point. For that drug to became main choice in opiod trade would be unrealistic expectation since carfentanil and fentanil producers and sellers are probably just optimizing and solidifying those instead for searching for the next big thing. At that scale and from mega-factories to skid row, neither legality nor safety seem to be of big or even any importance.

 

[AlsoTapered]

That mostly seems to be the case but since drugs in terms of TI and recreational value don’t strictly follow any kind of trends when it comes to their profitability I think in such a volatile market as USA opiod scene became (and some source countries are) I think it’s reasonable to expect rather safe and good stuff too will appear at some point. For that drug to became main choice in opiod trade would be unrealistic expectation since carfentanil and fentanil producers and sellers are probably just optimizing and solidifying those instead for searching for the next big thing. At that scale and from mega-factories to skid row, neither legality nor safety seem to be of big or even any importance.

Well U47700 was reasonable and their are more potent analogues but even those are only around x23 morphine.. and that's still to potent to be safe. The thing is that until the NOP receptor was identified, MOP agonists were the most powerful, usable analgesics so their are quite literally tens of thousands of patents covering 'novel analgesics' and about the same number of technical papers.

Sadly, very few people seem willing to really spend the time to sift through these papers to find the safest options.

Possibly isonortilidine (mentioned as the 'reverse ester of tilidine' on the Wiki page on tilidine) is actually a much safer and more euphoric opioid (since it's also a DRI and an NMDA antagonist) BUT it's only about as potent as morphine. At huge scales it's price would likely be very low but only at huge scales.

Sadly because of the legal position, these hugely potent compounds will always be far more attractive to a clandestine chemist.

Nortilidine WAS briefly an RC market and the few reports to be found on the Land der Träume (German language version of BL in many ways) were very positive. But I suspect someone had obtained tilidine and performed the 1-step N-demethylation that's in the original German patent concerning tilidine. I very much doubt that anyone found a synthesis that didn't involve tilidine and one of the tilidine precursors is REALLY expensive.

But someone MIGHT obtain a stack of naloxone or naltrexone and N-dealkylate it to noroxymorphone. From that you can produce homologues that are about 480x M but with an impressively large TI.

 

[TestLearnTeachModerate]

Hi, im a new poster, but a longtime reader/researcher/experimentor. During grad school it was prettt much my life's mission to experience all that could be experienced... Obviously this did not always turn out wel... In my 20s i hade a severe psychotic break that lasted 3 days (i parachuted 12gm of lorazapam, and went bananas like in 'a beautiful mind.' Havent touched benzos since... But today, just now, ive dissolved 4mg of the long skinny 2mg zanax bars, and am waiting for the results. I also took a 0.5mg suboxone just before. Im 15min in but still feeling compltely normal... Tempted to maybe crush snother one 2mg up and snort it and see how it goes... But i dont wanna go crazy again.... Should i wait a lil longer? All my tolerances are sky high...

 

[cant_overdose]

Hi, im a new poster, but a longtime reader/researcher/experimentor. During grad school it was prettt much my life's mission to experience all that could be experienced... Obviously this did not always turn out wel... In my 20s i hade a severe psychotic break that lasted 3 days (i parachuted 12gm of lorazapam, and went bananas like in 'a beautiful mind.' Havent touched benzos since... But today, just now, ive dissolved 4mg of the long skinny 2mg zanax bars, and am waiting for the results. I also took a 0.5mg suboxone just before. Im 15min in but still feeling compltely normal... Tempted to maybe crush snother one 2mg up and snort it and see how it goes... But i dont wanna go crazy again.... Should i wait a lil longer? All my tolerances are sky high...

Sometimes it's like that. One 1mg Xanax and a beer knock me right out one day, the the next I can take up to 7 or 8 pills and just feel nothing. IDK what that's about, body PH or some other biochemical change? Other meds you've taken can have an impact. I've bought pills, taken them home, then called the pharmacy to insist they never give me that brand again, only to find the same pills surprisingly effective the next time I take them.
You guys that know about the science behind this phenomenon, what is going on?