Hi there
@Deicide1212
If you're referring to the potential for Precipitated Withdrawal, the immediate onset of withdrawal caused by administering an Opioid antagonist to a person tolerant to Opioid agonists, this situation is actually the reverse of that. Precipitated withdrawal would be caused by taking Buprenorphine too soon while having been dependent upon Hydromorphone (Dilaudid) for some time.
If that is not what you're referring to, then the issue is more about figuring out the right dosage of Hydromorphone that will actually have the desired effect upon you. Buprenorphine is an interesting drug, as it is both an agonist and an antagonist, but for our purposes, we're talking about it like it's any other powerful Opioid, which it is. The antagonist properties would only come into significant play if the situation was reversed.
There is a lot of conjecture regarding the conversion of Buprenorphine to other Opioids, but there is enough information out there to help you make a safe and educated guess regarding this dosage.
8mg Buprenorphine taken sublingually is equal to approximately 240mg oral Morphine. Extrapolating, this would mean each 1mg Buprenorphine = 30mg Morphine.
Further, if both drugs are consumed by the oral route, each 4mg Morphine = 1mg Hydromorphone.
Let's say hypothetically, you're taking that 8mg Buprenorphine as your dose. We take our Morphine Milligram Equivalent, 240mg and divide this by 4 to arrive at 60mg Hydromorphone. These numbers might seem high, but we are discussing the oral route of administration for sake of understanding.
If you were to say, insufflate this Hydromorphone, you would then be doubling the bioavailability, making your number for equivalent effects at around 30mg Hydromorphone. I'm going to go with the crazy notion that you will likely be insufflating these, but if that is not the case, you can simply double the factors I'm about to lay out.
If 30mg is required to get that equivalency from 8mg Buprenorphine, we just divide that 30 by 8. So, for each milligram of Buprenorphine that you are taking, you would need 3.75mg Hydromorphone insufflated or 7.5mg by the oral route. Of course, if by chance you're injecting the Hydromorphone, you would increase the oral dose by a factor of 3 as opposed to 2, leaving you with essentially a milligram for milligram equivalency to your sublingual Buprenorphine.