Bupe Horrible precipitated withdrawals from IV bupe... thought this couldn't happen?

[dittybopmonster]

muvulotion, i know this is a dumb question, as I know you prolly know your shit. But have u ever injected bupe when you werent dependent on a full agonist opiate? For any stretch of time that I dependent on dope, subs throw me into precip wd literally 80% of the time that I switch over. Ive waited 24 hours before and been thrown into the quintessential precip withdrawal. 30-45 mins of glass shard up my peehole pain

 

[Swimmingdancer]

I have personally injected suboxone at a dose between 1-2 mg. It is a common misconception that the naloxone will cause precipitated withdrawals. You will however experience precipitated withdrawals (no matter the route of administration) if you take buprenorphine products like suboxone or subutex, while other opiates are still in your system. Here is some info with sources about this.

"Suboxone contains buprenorphine as well as the opioid antagonist naloxone to deter the abuse of tablets by intravenous injection. Even though controlled trials in human subjects suggest that buprenorphine and naloxone at a 4:1 ratio will produce unpleasant withdrawal symptoms if taken intravenously by patients who are addicted to opioids, these studies administered buprenorphine/naloxone to patients already addicted to less powerful opiates such as morphine.[3][4][5][6][7] These studies show the strength of buprenorphine/naloxone in displacing opiates, but do not show the effectiveness of naloxone displacing buprenorphine and causing withdrawal symptoms. The Suboxone formulation still has potential to produce an opioid agonist "high" if injected by non-dependent persons which may provide some explanation to street reports indicating that the naloxone is an insufficient deterrent to injection of suboxone.[8][9] The addition of naloxone and the reasons for it are conflicting. Published data clearly shows the Ki or binding affinity of buprenorphine is 0.2157 nM, while that for naloxone is 1.1518 nM.[10] Furthermore, the IC50 or the half maximal inhibitory concentration for buprenorphine to displace naloxone is 0.52 nM, while the IC50s of other opiates in displacing buprenorphine, is 100-1000 times greater.[11] These studies help explain the ineffectiveness of naloxone in preventing suboxone abuse, as well as the potential dangers of overdosing on buprenorphine, as naloxone is not strong enough to reverse its effects" (source).

"It is a common misconception that the Naloxone in Suboxone initiates precipitated withdrawal. This is false. The Naloxone can only initiate precipitated withdrawal if injected into a person tolerant to opioids other than buprenorphine. Taken sublingually the Naloxone has virtually no effect" (source).

I hope that helps clear a few things up for you.

Thanks Tommyboy, that is very interesting. What the first excerpt doesn't cover though is people who have, say, been dependent on opiates but have maybe gone a few days without using, or people who are dependent on bupe - it's my understanding that those sources were just talking about opiate-naive people. I also don't think that one can make the leap - as some posters have - that therefore it is impossible that injecting Suboxone, especially at high doses, can cause any withdrawal symptoms and that anyone who says they experienced that is lying or confused. I think it just means that the naloxone is not guranteed to do so in everyone. The second excerpt is an unreferenced statement in Wikipedia, which is meaningless since it's the "encyclopedia that anyone can edit", and I have seen a LOT of false info on Wikipedia, so am very skeptical of anything in a Wikipedia article that does not have an inline citation.

All these statements really prove is that studies and reports on the precipitated withdrawal effect from injecting Suboxone are conflicting and seem to vary from person to person. The only thing that sources seem to agree on is that if you have recently taken any other opiate Suboxone will put you into withdrawals - but anecdotal reports seem to disagree even on the length of time that one needs to go before you can use Suboxone without this effect. I think it just really depends on the person, their metabolism/physiology/etc and the particular circumstances.

Personally I would not take the chance as it is not worth risking WD to me Ugh, I HATE withdrawals!!

 

[Tommyboy]

When I IV'd the suboxone, I was somewhat dependent on opiates (mild withdrawal if I discontinued use) and had taken suboxone sublingually for 3 days before IVing the 1-2mg dose.

Most people that IV suboxone after using other opiates first take the drug sublingually during the induction period before switching to IV.

The effects of suboxone certainly depend on the person. This goes for anything from how long they need to wait after their last dose of another opiate before dosing suboxone in order to prevent precipitated withdrawals, so how long they must wait to take another opiate after taking suboxone to prevent the blockade effect, and apparently if the person can IV it at all without experiencing precipitated withdrawals.

There are countless threads started here asking "how long after taking [insert opiate name here] do I have to wait before taking suboxone to make sure I don't go into precipitated withdrawal?" to "how long after my last dose of suboxone do I have to wait to feel the effects of [opiate of choice]?" These countless threads are frustrating to answer, because as you see, everyone is different, and it seems that suboxone (more so than other opiates) affects everybody differently.

 

[Znegative]

Why are you so sure about this? What are your sources? That is certainly not what I've read. *confused*

here's some less anecdotal stuff on the topic, it's from The Fix, this online recovery-type magazine

"In the U.S buprenorphine Is usually prescribed in 2 and 8 mg Tablets. Two generics are on the market:subutex is bupe only, And suboxone contains Four parts bupe to one part naloxone, an opioid antagonized designed to Prevent addicts from abusing the drug. If crushed and shot or snorted, the manufacturer Says the naloxone will put the user into withdrawal.

'that's just dishonest advertising', says doctor Steven Scanlan,a psychiatrist and addiction specialist...'The naloxone doesn't prevent you from shooting it. I've talked to dozens of people who have shot or snorted it.'"

Here's the website I got it from

http://www.thefix.com/content/best-kept-secret-addiction-treatment?page=all

Also I don't know how many people here got on suboxone around 2006-7,but if you did, at that time they were telling you that if you even snorted it you would go into withdrawal. So think about the whole thing, it's a bunch of bullshit. The naloxone is magically not at all absorbed during sublingual? It may not, but since only 30% only of bupe is absorbed sublingual, and the rest is swallowed than that means that the naloxone which they claim is active orally would still pretty much all be absorbed if you don't spit, but yu don't see people going into withdrawal from taking suboxone the "right" way

 

[muvolution]

I have shot it a few times. Once when in w/d's (it made the w/ds worse then. Once was when I had been sober for a long while - I immediately felt like shit. The last time I did it I was clean again, and I got massively sick as soon as I shot it.

so... YMMV??

 

[Znegative]

Muvolution, Have you shot regular subutex? I'm just wondering if perhaps you have a weird reaction to buprenorphine in general. Also I believe suboxone has a lot more weird binders in it than subutex. I can see that perhaps some people have an extreme sensitivity to naloxone and maybey that could be your case. But for the most part it just doesn't make sense that sniffing suboxone would cause withdrawal any more than shooting it as I imagine naloxone has a high enough BA through insufflation. And the same thing goes for even sublingual, which was what I was trying to say before. Since 70%of the buprenorphine ends up being ingested orally in suboxone anyway, than wouldn't the remainder of the drug that didn't get absorbed sublingually end up in your stomach including the naloxone,? I mention that because the suboxone doctors I've had always seem to bring up how "neat" suboxone is because the naloxone does not get absorbed well sublingually, but does get absorbed well orally, whereas buprenorphine is the opposite.

I want to stress that I'm not calling anyone a liar, and I'm by no means a chemist or scientist by any rite (I draw ha) but the whole naloxone buprenorphine thing just seems like some illogical thing that suboxone manufacturers put out to try and confuse the junkies. Then again as with all things there are some people that are the exception, and the naloxone does work in their case. Especially if you shot 2mg and under, while sober and still had the bad reaction, it's just strange.

In the suboxone pamphlet that comes with the strips, they even say that in the event of a buprenorphine overdose, larger than normal quantitys of naloxone would be needed as well as perhaps an additionally stronger antagonist, to pull the person out of it. So according to there owne literature they kind of admit to the ineffectiveness of the naloxone in the suboxone formula, but at the same time they're saying that very high dosages can be used to pull someone out of an OD. So who knows? I just think its a matter of sensitivity.

 

[Tommyboy]

Poll?

 

[Missykins]

I have personally injected suboxone at a dose between 1-2 mg. It is a common misconception that the naloxone will cause precipitated withdrawals. You will however experience precipitated withdrawals (no matter the route of administration) if you take buprenorphine products like suboxone or subutex, while other opiates are still in your system. Here is some info with sources about this.

"Suboxone contains buprenorphine as well as the opioid antagonist naloxone to deter the abuse of tablets by intravenous injection. Even though controlled trials in human subjects suggest that buprenorphine and naloxone at a 4:1 ratio will produce unpleasant withdrawal symptoms if taken intravenously by patients who are addicted to opioids, these studies administered buprenorphine/naloxone to patients already addicted to less powerful opiates such as morphine.[3][4][5][6][7] These studies show the strength of buprenorphine/naloxone in displacing opiates, but do not show the effectiveness of naloxone displacing buprenorphine and causing withdrawal symptoms. The Suboxone formulation still has potential to produce an opioid agonist "high" if injected by non-dependent persons which may provide some explanation to street reports indicating that the naloxone is an insufficient deterrent to injection of suboxone.[8][9] The addition of naloxone and the reasons for it are conflicting. Published data clearly shows the Ki or binding affinity of buprenorphine is 0.2157 nM, while that for naloxone is 1.1518 nM.[10] Furthermore, the IC50 or the half maximal inhibitory concentration for buprenorphine to displace naloxone is 0.52 nM, while the IC50s of other opiates in displacing buprenorphine, is 100-1000 times greater.[11] These studies help explain the ineffectiveness of naloxone in preventing suboxone abuse, as well as the potential dangers of overdosing on buprenorphine, as naloxone is not strong enough to reverse its effects" (source).

"It is a common misconception that the Naloxone in Suboxone initiates precipitated withdrawal. This is false. The Naloxone can only initiate precipitated withdrawal if injected into a person tolerant to opioids other than buprenorphine. Taken sublingually the Naloxone has virtually no effect" (source).

I hope that helps clear a few things up for you.

With all due respect N=1 does not make a drug study, and Wiki does not equal Lange Clinical Anesthesiology.

 

[Tommyboy]

Look up their sources then. They list them on the bottom of the page. And with all due respect, the OP does not make a drug study. That's kinda why I wanted a poll.

For the binding affinity;
Donna A. Volpe, Grainne A McMahon Tobin, R. Daniel Mellon, Aspandiar G. Katki, Robert J. Parker, Thomas Colatsky, Timothy J. Kropp, S. Leigh Verbois. Uniform assessment and ranking of opiod Mu receptor binding constants for selected opiod drugs. Regulatory Toxicology and Pharmacology. 2011. 59. 385-390.

IC50 of opiates displacing naloxone or bupe;
John W. Villiger, Kenneth M. Taylor. Buprenorphine: characteristics of binding sites in the rat central nervous system. Life Sciences. 1981. 29(26). 2699-2708.

 

[Znegative]

Even my suboxone doctor admitted today that the naloxone is a ploy for R&B to keep a patent, though she said that with all the abuse of suboxone, she fears that theyre going to crack down even harder on suboxone regulations. And as a side not for all those wondering about the codes on the strip, according to her, she said she talked to a R&B rep, and was told that the codes will be used to track down the pharmacy the strips were dispensed at, the psychiatrist who prescribed it, and finally the patient. However, she said that as of yet, this system is not established, i.e. if you've "lost" your suboxone strips you don't have to worry about it as of yet.

And let's do the poll

 

[SUB SHOOTER 2010]

When I IV'd the suboxone, I was somewhat dependent on opiates (mild withdrawal if I discontinued use) and had taken suboxone sublingually for 3 days before IVing the 1-2mg dose.

Most people that IV suboxone after using other opiates first take the drug sublingually during the induction period before switching to IV.

That is the way to do it. He is correct. I have years of experience with bupe, switching back and forth from bupe to heroin to bupe to opana to bupe etc. You can IV subutex as long as you are withdrawing and it wont make you feel shitty. IVing Suboxone does for like 15-20 min even if you are withdrawing. And the only time that IVing suboxone will make you feel shitty is when you don't take it sublingually first and get it on your receptors. BOTH subutex and suboxone will make you prec withdraw if you are opiate dependent and not in withdraw when you IV them.

This is where a lot of people get confused too about IVing suboxone. They hear that they can IV it then they do it when they are coming off an opiate binge and they are actually withdrawing and it makes you feel like really fucking weird for about 15-20 mins, extremely uncomfortable.

This has to be the naloxone in the suboxone causing this, because you can go straight to shooting subutex while your withdrawing and you wont have these same effects. And it is not a prec withdraw because when the bupe causes a prec withdraw that shit lasts way longer than 15 mins. Usually I dont feel better from prec withdraw for at least a day.

 

[Znegative]

YEah, that is true, precipitated withdrawal seems to be intense for three or four hours and then sort of fucks up the rest of the day, though the worst is over

 

[Captain Quantum]

That is an absolutely eye-popping dose!

According to a quick conversion that is equal to approx 400mg of methadone. Wowza

When people OD from bupe, it takes quite a lot of narcan to get them up again. Like continual dosing, if I remember correctly. "In managing a Buprenorphine overdose, high doses of naloxone hydrochloride (10‑35 mg/70 kg) may render only limited value...." That dose made me quiver a bit just thinking about it.

But I gotta say, I've seen several inconsistent reactions from IV sub. A couple of times when I've done it (all whilst on maintenance) I've had a strange reaction that lasted only about 5-10mins and then settled into an ok high. Just a quick feeling of withdrawal and terror, then its gone...I do know people who IV tiny doses everyday w no probs at all.

 

[Znegative]

No it's not equivalent to 400mg of methadone, because buprenorphine has a cieling effect, you can only convert buprenorphine in comparison to a certain point. Ive heard it's peak opioid effects are equivalent to somewhere around 30-50mg of methadone.

I've experienced a slight icy feeling after injecting bupe that would last maybe two minutes, but it wasn't precipitated withdrawal, and that only happened if I've been taking it through another roa for a while. However when I was primarily using low dosages of iv suboxone, I never experienced it.

 

[Captain.Heroin]

I have shot it a few times. Once when in w/d's (it made the w/ds worse then. Once was when I had been sober for a long while - I immediately felt like shit. The last time I did it I was clean again, and I got massively sick as soon as I shot it.

so... YMMV??

Were you using micron filters??

 

[Tommyboy]

I ended up starting a poll on the topic of precipitated withdrawals and IV suboxone here.

 

[muvolution]

Yes I was. I will get a poll up when I am on a real computer.

 

[Tommyboy]

^ I was saying that I got the thread going already, and BDP added the poll options for me. They are in the link in my post above yours.

 

[Swimmingdancer]

^ I was saying that I got the thread going already, and BDP added the poll options for me. They are in the link in my post above yours.

Was it maybe an edit conflict? Like muvolution was trying to post at the same time as you and was replying to the post before your's?

 

[THE_REAL_OBLIVION]

Hey.

No I didn't the only time I tried. I didn't have better filters that SecuriCup filters, (filters found in the sterile cups in injection kits given in my country). They're good for Dilaudid or Statex (Morphine IR that is not fucking dangerous like MS IR's to shoot up), but I was so idiotic at the moment. Let me explain. Suboxone pills in Canada are not Orange like they were in the US, they're white. They are highly acidic and contain natural and artificial lemon and lime extracts as flavour. I imagine the american ones tasted like chewing a vitamin C pill? We don't have Subutex here, we were promised it in 2005, but then I gave no shit about opiates, but the Rickett said no wait, we got something better and we had Suboxone forced upon on in this form.

Injecting a 2mg quarter of a pill created a burning sensation all up in my arm and skipped heartbeats and some problems breathing for a month. DON'T FUCKING DO THIS WITH CANADIAN SUBOXONE, we don't have strips here. I asked about Zubsolv though, not even for IV, just for the even better B/A, they won't let heroin from switzerland in, maybe they will allow me to have Zubsolv, because this suboxone stuff is a crap deal and it's so acidic I know 2 patients I talked to a bit in the waiting room when I have my appointments to renew the script, and their front lower teeth are being eaten away by the suboxone.