Opioids Quick question about Subutex induction

[trip407]

I was on 900mg oral morphine or 500-1000mg i.v. heroin depending on quality and decided to cut down and switch to subs.
So the last days went like this:
29.04.2017 300mg oral morphine
30.04.2017 200mg oral morphine
01.05.2017 50mg oral morphine + 1 bag very bad Heroin (snorted)
02.05.2017 50mg oral morphine, 200mg Tramadol

So i thought today i was ready for the subs, and i woke up 0400 and snorted 600ug maybe, then woke up dripping in sweats and snorted another 1,4mg for a total of around 2mg. But i don't know if i felt better or worse from it so abstained from doing a higher dose. I don't want to use high doses of bupre anyway. Maximum 3mg , is there a reason i got no relief from 2mg Subu? It should be almost equal to 200mg morphine. Or was the dose way too low for my tolerance? I was desperate after i thought the subs didn't work i added 200mg tramadol in the mix, when can i redose the sub?

 

[adder]

A rough estimation of the conversion ratio from oral morphine to s.l. buprenorphine: i.v. buprenorphine = 20x i.v. morphine = 60x oral morphine. Assuming 30% bioavailability of s.l. buprenorphine, then 1 mg s.l. bupe = 18 mg oral morphine.

It is a rough estimate but nonetheless with such a high tolerance you're probably going to need the maximum reasonable dose of buprenorphine. There is a ceiling effect with buprenorphine around 8mg s.l., at a certain dose your opioid receptor system is almost saturated with buprenorphine and you can't get much more opioid effect by increasing the dose (although you definitely can overdose on buprenorphine but it has a larger safety margin). Calculating the dose while switching from one opioid to another is as simple as using a conversion chart though as different opioids show different cross-tolerance one with another, so when you switch, you always start lower and then try to find the right dose by increasing it. It's possible though you might not get full relief from buprenorphine even at the highest dose.

Buprenorphine-induced changes in mu-opioid receptor availability in male heroin-dependent volunteers: a preliminary study.

Here is an article from 2000 that examined the effect of buprenorphine dose on opioid receptor occupancy. The results show that at 16mg s.l. the occupancy is ~90%, based on this increasing the dose up to 16mg or even beyond may have some additional opioid effect, but in the 8-16mg region the dose-response curve is likely very slowly rising close to flat and reaches saturated somewhere beyond 16mg (I imagine full saturation dose would be an overdose).

 

[tacodude]

I think tolerance is the bigger factor for overdose were those tolerant enough can't Od on it as well as possibly some can't get full relief just minor as I thought it was impossible until a 2 year old was found unresponsive after overdosing an 8 mg strip (seriously how did they two year old get into a strip package? It's sad the baby if able to grow probably would've been really smart.)That doesn't mean I think the op (or anyone) should just takemoartillsfeelsgood. It does sound like PWD occurred though in op case.

Were you in wd before taking the subs? I don't mean just feeling unwell, but to the point of yawning every three seconds, pouring sweat, shaking, temperature fluctuations, goosebumps, and/or whatever symptoms of measured using the clinical opiate withdrawals sheet/system (COWS) that should've been severe mild withdrawals at the Minimum, which is 5+ I believe. Although it's better the worse you let it get even you used the subs as you'll not only get relief, but will feel a lift as you go from feeling like shit to much better in 5-15 minutes after the sub sits for a good minute. You want to wait 24 hours after the last dose, which due to using pro drugs and I'm assuming er Morphine formulations maybe at least 36 hours giving 12 hours for the Morphine to stop releasing before counting the 24 hours.

 

[Phil.McKeer]

IME, during induction onto bupe from high dose full agonists, sometimes unusually high doses are required...I had to take 12-16mg on induction but then comfortably dropped the dose to 4mg the very next day and 2mg the day after that, eventually getting down to 0.5mg by the second week at the latest.

Your experience may vary but at nearly a gram of oral morphine per day I think it's ok to induct at a higher dose (when you are good and ready as tacodude mentioned).

 

[Methacodone]

Adder wtf are you talking about? Buprenorphines ceiling effect at 8mg!?

No. The ceiling effect of Buprenorphine is in the 32-36mg range.

 

[trip407]

First question first, it was hard to measure how bad in withdrawals i actually was, because i had used a variety of medications to mask the symptoms, for ease of reading i deleted these substances from my consume log. To name a few this is clonidine, loperamide, lyrica, weed/syntetic noids, amphetamine + a variety of benzos and ethanol. I know i have a massive polydrug problem, don't judge me.

Unfortunately i used heroin at 02.00 PM, it was not much and i only insufflated it, a strange feeling of half high and half in withdrawal followed.
I was psychologically fine, it was a taxing day, in this regard. But i am draining in sweat, and am freezing. I have also a feeling that the dope wears of much quicker as usual, my pupils are already dilated again just 4 hours after the dope. Some kind of blockade must be in place. I'll sleep at a friends place to be safe and will be getting new subs at the most early time around 11.00 AM the following day. I want to try it again in a bigger dose, and in more heavy withdrawals, no need for excessive medication. 5mg Diazepam for the night and maybe some pregabalin if im in very bad shape tomorrow morning. Is this reasonably safe? as the dope should be out of my system almost 24 hours later. I fear i am fucked if the buprenorphine will not help tomorrow i can't use any another full agonist on top...

This addiction is messing bad with my psyche, i cant repeat this cycle usage till my tolerance is through the roof and its impossible to get high anyway. Although money is not the problem, its taxing in its own aspects, i lost all interest in what is fun in life. Even sex is just work i rather have sooner ended then later to get my next shot...

I feel so damn lost...

 

[tacodude]

Adder wtf are you talking about? Buprenorphines ceiling effect at 8mg!?

No. The ceiling effect of Buprenorphine is in the 32-36mg range.

maybe iv it's 8 mg or even 8 mg is active in the system not necessarily the dose taken

Edit : you'll be fine tomorrow if you wait. The bupe will still be in your system from the last dose so tonight will be easier. Trust me when I say anxiety triggers physical withdrawal sensations.

 

[Phil.McKeer]

OP, don't just go by hours. 24 is a good average benchmark for the average amount of time the average person requires to be safe for induction but you might be an outlier in the bell curve.

Wait at least 24 hours but also go by how you feel. You want to have been in profressively worsening withdrawal for some time before you dose the bupe - use the COWS worksheet to grade your level of withdrawal - i recommend an objective score of at least 20 before induction. Trust me, you'll feel the relief soon enough if you wait the adequate amount of time. It's worth it.

 

[trip407]

Ok i almost could not get any sleep this night, by the time i got home 07:00 am i was at a cows of 15-20 and i used whatever small chunk of this 8 mg pill i have left. It helped to take the edge off, so i guess i am fine if i take more when i get more by midday. I might even catch another hour of sleep, now. Thank you i might report back later how much i needed....

 

[Phil.McKeer]

Trip, just fyi - if you took a crumb earlier while in w/d and felt some relief, you should be safe to take a larger dose, like 4 or 8mg. I still recommend taking it 0.5-1mg at a time, nevertheless (every 30 mins or so).

 

[trip407]

I would, i just don't have more right now. I need to get my weekly script for 6,3g morphine sulphate and while doing so will buy more subs.

I found that on induction the subutex needs unusually long to be felt. I was in a clinic once 5 days off of every opiate and i could feel the s.l. effect only after one hour. But by night i was well overdosed, up all night scratching my body, unable to sleep. And i came down from a particularly nasty 160mg methadone + diazepam habit. Same now the peak of nasal dosage lasted well into the 30-60 minutes. Lucky, i was taken by surprise how well it worked after a while, took a small nap and feel now only lingering Wd's. Another 1-2 mg will fix this for sure. Psychologically i am already all good, dancing with my head to music, am talkative so i stop this now.

Adder your conversion must be off somehow 1mg buprenorphine is much stronger then 18mg oral morphine. Even without tolerance i barely feel anything from 50mg oral morphine.

 

[tacodude]

In the beginning more is needed for the first few doses, but it's easy to jump down under 1mg after you're induced in fact people find less is more. You can also use on top of life doses like 1 mg or less sub in the morning and at night an immediate release 12 hours later then 12 hours the suboxone again and you can go back and forth, but it will raise your tolerance more than help it likely unless you also use low full antagonists doses.

I also found suboxone made it impossible for me to sleep without cannabis and it took a lot. There was a study I'll link below about how bupe affects sleep. They use Lunesta to counter the issue with success so I assume other similar non benzo z drugs will work like ambien.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197808/

 

[trip407]

Woha, i used a total off 4 mg subs yesterday. And on top a small midazolam/morphine cocktail, and one with street gear and midazolam. More midazolam through the day, but nothing else beside some weed.
I woke up without any withdrawals at all and took 2mg. I hope i can cope with buprenorphine, the urge to inject something like opiates, midazolam, amphetamine is unfortunately there.

If i would switch into a tapper, i should obviously don't use on top and use less every day, then every other day then stop altogether. Can i safely assume my tolerance is much smaller with ~2mg buprenorphine per day vs. 900mg oral morphine? So my first goal should be to find a reasonable stable dose and go slowly down from there.

 

[Methacodone]

Hell yes your tolerance is smaller with 2mg (SL ) buprenorphine than with 900mg (oral) morphine.
Equivalent doses on the opiate equivalent chart states that 0.4mg (SL) buprenorphine is equivalent to 10mg (oral) morphine.
Your also most likely wasting your morphine using it on top of buprenorphine, as it blocks most opiates used on top.

Also, buprenorphine has a half life of 24 to 72 hours, so of course you wont hit wd the very day after you dose with the proper dose and tolerance.

 

[trip407]

Just an update if anyone is interested. I have now induced a second time. If i feel shitty in the first days with bupre, i use a little bit of full agonist on top, most of it will be blocked anyway, but it helps with the pain and cravings. And after there is a stable level of buprenorphine in my system i just drop the full agonist and will not have any withdrawal symptoms. Unfortunately i have these cravings to i.v. ANYTHING within my reach. But i need to have a sharp mind, because i start a new but easy job next month.