Bupe Suboxone Induction questions about pre induction substances(urgent)

[substitute_teacher]

Hey guys, I have been around b-light for years, but it's been a while and cannot remember my old login/password info, so back to being a "greenlighter". Anyways I have a few fairly urgent questions that I am hoping to get answered or some feedback on. I have been a pain patient for a number of years, but I am too young to be spending the rest of my life in and out of doctors offices and especially as I live rural and dealing with finding a new doctor after another one of my doctors moved away again is a challenge. I am over it to say the least.

I plan on taking suboxone (plugging it) and have a number of questions and concerns in relation to pre induction hours of being sick and safety of taking benzo's and clonidine etc.

It may end up being a long post, what I am going to do is outline my one prior experience with sub induction (bad experience) so everyone knows where I am coming from and then I will post my questions and plans for the induction this time around. Anyone who just wants to cut to the chase and read the question I have can skip to the bottom paragraph.

Here is some background of my last experience, its long so anyone who wants to cut to the chase, the questions are below this paragraph.



Background- I have acquired suboxone and have only attempted induction one time and it did NOT go well, to say the least. I have extreme stomach issues where nausea and vomiting are near daily occurrences. I assume like many others who experience regular nausea, I have lots of saliva and spit when I am about to get sick and if I dont spit, i will get sick. Anyways to cut to the chase about the previous experience, I waited about 17-20 hours from last dose (its been a while cannot remember exact time I took sub), which at the time was BTH, very low grade to be honest. I ended up generating so much saliva from the combination of my regular nausea, coupled with being in w/d's and the sub strip. I believe at first I only took maybe 1-2 mg. I generated so much saliva I looked as if I took a few gulps of water and just left them in my mouth without swallowing. Picture holding water in your mouth; i.e. puffed out cheeks and all. There was just not enough surface area for the sub and liquid it was now mixed in to absorb.

I ended up also not being able to hold it in my mouth for even five minutes, which resulted in me having to keep eating more subs to compensate lack of absorption. In the end, I even went against my knowledge of subs and pharmacology and swallowed the sub liquid to get rid of some of my saliva, as spitting is a complete waste and I needed to reduce the amount of liquid in my mouth. I know bupe doesn;t really work when swallowed due to low B/A and potential for nausea.
Well at one point after an unknown amount of sub was tried, I got a little hint that relief may be coming, but then a total change of headspace came about where my anxiety went through the roof and I started getting more uncomfortable by the minute.
I couldn't sit, couldn't stand, cold sweats then burning up like I was extremely hot, skin crawling sensation, restless legs/arms/ shoulders. I would normally say someone with this experience went into precipitated w/d's, but to me it felt more like I was just getting sicker and deeper into w/d's and I just couldn't get the bupe to absorb. My lady had more or less the same experience (We were doing it together).
I should add the increase of anxiety could have played a bigger role than anything else in how I felt at that time in question. At one point I just couldnt take it anymore. I had plenty of pain medications and access to BTH and even an endless supply of valium and xanax, but I wanted to be on subs and refused to take it. I ended up driving myself in a haze (don't advise this, bad idea) to the hospital in hopes of maybe some relief can be had after fluids and maybe valium or??.

Anyway I didnt even go in past the check in, as I spoke to a doctor or nurse and in the end they couldn't really do much for me or my situation other than fluids. I guess I could have taken a valium and it would have brought the anxiety down a bunch, but I seriously do not like mixing benzo's and opioids, especially one that I have no experience with and was unsure my actually required dosage and it's effects. I ended up leaving and using BTH, which I should add took a shit load more than normal to even feel any relief. That does in fact make me believe I must have had *some* bupe in my system by then. (Even thinking back, if I pushed the anxiety aside maybe I even felt a little better by then, but unsure as I was having extreme nausea) I ended up throwing up orange sub saliva foam/froth/ bile all afternoon and evening, well into the night.

It continued until all I swallowed earlier was out of my body. I do not recommend swallowing. I swore I would never take subs again, which was very unfortunate since I went into that experience with a extremely positive mentality.



------------------------------ Current Question and inquiries:

So tomorrow I plan on trying sub induction again. I absolutely cannot do it orally, so thats out of the question. For those who read the above background of my prior experience (thank you to those who did) will understand why I cannot. I am going to plug it, as rectal administration is both a safe choice and will bypass most of my issues from last time. I don't have any questions pertaining to the administration of bupe rectally, rather my questions have more to do with the pre induction time, more specifically when I am in W/D's. Basically my last dose of BTH (smoking) will be approximately 4pm today. I pretty much always stop using every day by 4pm and usually don't use until I wake up the next day, which is usually between 3:30 am and 5:30 am. I more or less wait 12 hours in between my doses everyday.
When I wake up I will be feeling crappy and within an hour from there I will be really feeling the w/d's. I have a few questions about what I can take while being safe BEFORE enough time has passed to take the first sub plug. I have at my disposal a pretty much endless supply of valium (10mg) and xanax (2mg). I have a fairly large amount of Clonidine (never taken but heard it helps for most people) and I have immodium which Im not even thinking about using. I also have some kratom, which I didn't plan on using. What I need to know is what is the best plan of attack, in terms of substances to take to aid the symptoms of W/D prior to me being able to take subs. I most likely will have anywhere from 5 hours to 10 hours to kill while feeling really shitty from withdrawal. For me the cold sweat then burning up hot, restless legs,arms and shoulders and the anxiety are the worst symptoms for me. I usually suffer from RLS so my legs really get to me and my legs and arms/shoulders from chronic pain issues don't help either. So keeping in mind I prefer not to take a benzo and then sub shortly after when would it be a SAFE time to take the benzos? I assume I can take a valium or a xanax right when I wake up (lets say 330 am/last dose 4 pm previous night).

1) When would be a smart time to stop taking benzo's in order to remain safe, in relation to the ideal time to take subs (again 4pm last dose previous day)?


2) Whats better to take for these circumstances, valium or xanax?


3) Is it safe to take clonidine with the benzo when I wake up (or feel the need for it)? From what I hear it would help with RLS and Hot/cold sweats. I should add my BP is completely normal under normal circumstances. I've heard about some side effects like getting light headed, so I just want to ensure safety of taking this with either xanax or valium and then within 5- 10 hours taking suboxone.

4) Can kratom be taken before subs? Specifically does kratom usage the hours leading up to induction create a chance of precipitated w/ds? If someone can help create a plan of attack for me, while keeping in mind my last dose of BTH and the ideal time to take the sub rectally I would be very very grateful. If you can include answers to my questions about safety and taking benzo's in the morning leading up to induction that would be great too. Also if the question about clonidine and benzo's together in regards to safety can be included in the answer that would be amazing. Thank you guys very much, I really appreciate anyone who can take the time to read and answer some of these concerns of mine.

-Much love all-

 

[albatross]

Try your best to abstain from all opiates for 48-72 hours before dosing buprenorphine.

Taking benzodiazepines in the interim would be helpful for withdrawal symptoms but will increase respiratory depression exponentially with buprenorphine. Because of that, only dose the benzo if you are tolerant to it and even then only super low doses.

I have taken buprenorphine after dosing kratom and I did not experience precipitated withdrawal. This does not mean the same will be the case for you as everyone is different.

 

[substitute_teacher]

Try your best to abstain from all opiates for 48-72 hours before dosing buprenorphine.

Taking benzodiazepines in the interim would be helpful for withdrawal symptoms but will increase respiratory depression exponentially with buprenorphine. Because of that, only dose the benzo if you are tolerant to it and even then only super low doses.

I have taken buprenorphine after dosing kratom and I did not experience precipitated withdrawal. This does not mean the same will be the case for you as everyone is different.

Thanks for the reply. I understand it's obviously wiser to wait 48-72 hours before taking bupe, as that would pretty much eliminate the chance of precipitated w/d's (with short acting opioids). I am not going to lie, I cannot wait 48-72 hours (well i can but not ideal for my intended plan) and if I did wait that long, I would just stick it out cold turkey because honestly I am only doing the suboxone with the intention of a quick taper down until off completely. The cravings and other symptoms such as PAWS isn't really my issue, rather it's easing some of the w/d symptoms to a more manageable level.
I appreciate your quick reply and will take it into consideration. At the moment I am aiming for 24 hours after my last small dose.

I guess I should consolidate my questions in hopes of receiving some specific answers.
I don't plan on taking benzo's and subs together. As stated I don't like the idea of mixing benzos and opioids of any type, as I lost way to many friends with such combinations. (I understand most of these incidents were with much higher dosages of both, compared to my bare minimum needed to relieve w/d symptoms, still don't like the idea)

How long before taking subs should I stop taking benzos?
I guess depends on which benzo, so in that case which benzo is more ideal for my scenario, diazepam or alprazolam?

If I were to hypothetically take one of the two mentioned benzos 5 hours prior to my plan of taking .5-1.5 mg of bupe as my induction dose would that be SAFE?
-I am asking in terms of safety and am aware nobody can say for certain, but it would help to get a better idea of safety and how long I need to cease taking benzos before sub induction.
-I assume xanax may be safer to take as the half life is shorter, in turn making it fairly safe to take a dose of xanax 5 hours before plugging the sub dose.
-Which benzo is ideal?
- I assume valium will ease more symptoms due to its hypnotic properties and even sometimes prescribed for RLS.
- Xanax has shorter half life
- If valium is my choice how long should my last dose be BEFORE taking my subs (i assume five or more hours should be fine)
- If xanax is my choice how long before subs should my last dose be? (Once again I feel five is safe, especially with xanax and its short half life and duration)

Also a rephrased question about clonodine,
I have never taken it before, but my GP prescribed it in prep for eventually detoxing. i don't have high or low bp, rather normal healthy BP in a normal scenario. It worries me that it could possibly make my bp too low. I will get a auto BP checker from pharmacy if they have any, so I can monitor my bp to ease anxiety of the situation.

Can Clonodine be taken with either xanax or valium when I wake up (~12 hours after last dose of opioids) to ease some symptoms?
- I assume yes, as my doctor prescribed both with the intention of easing symptoms.
- What symptoms do I need to look for and be concerned about?
- What happens if my BP gets too low? What do I do IF it gets too low? What BP level is actually cause for concern (anyone who can provide info on healthy/normal bp levels, high and low it would be appreciated)

Thanks a lot!

 

[albatross]

I'll give a quick answer to your question on benzos and subs. Short acting benzo like alpraz would be best. Give yourself 8-12 hours at least after alpraz to be safe.

 

[sm0kestack]

I would prolly say taking xanax to keep you sedated for that first day would be best since it indeed has a shorter half life than other benzos like valium and klonopin, it has better knock out effects and kicks in more quickly, and leaves the system faster.

So yeah, I would just use the xanax in just small enough doses to enable you to sleep thru the first 24 hours. And really , I would say, if you can get your hands on some gabapentin (neurontin) or pregabalin (lyrica), get them. In high enough doses, they will pretty much ease all withdrawal symptoms, pretty amazing for not being opiates, but they do hit some of the same receptors and neurotransmitters in your brain that are imbalanced like dopamine, which is the underlying cause of restless arms/legs/shoulders. But if you cannot get them, .1mg clonidine every 6 hours is fine with the xanax. It doesn't really help much with the RLS, but it does help with the sweating and some anxiety since it does lower BP. Just be careful not to over-do them cuz you can bottom out. I never liked clonidine really, it gives me horrible dry mouth, and that loopy drugged up feeling. Yeah stay away from the Imodium if you plan on taking bupe soon.

After that first 24 hours after your last dope usage is up, you should be nearing the time where it's safe to go ahead with bupe. Take your last xanax at this point and plan on going ahead with the bupe around 30-36 hours. If you were using a short acting opiate, and your dope is not cut with something long acting, you should be 100% safe to give it a go. Remember start low, 1mg or so to start off. Since you are plugging it will lick in quickly like in 15-20mins, and be at full effects in an hour. If you precipitate withdrawal, it will be mild, and at that many hours , the bupe will settle in and you will prolly be like whoa I am feeling better. Then from here dose more bupe as needed til you are where you want to be.

The kratom, I would honestly save this stuff if you wind up having to deal with PAWS (Post Acute Withdrawal Syndrome), or if you over take suboxone and need something to taper that off. And I would keep some of your benzos for this time ONLY when you have sleepless/restless nights. The Imodium can also be used here too, just for any lingering gastro intestinal issues.

Overall the time span for all this should be done in 1 week or 2. Usually it takes me 2 weeks with a medium dope habit. With a small one I'm generally kool in a week.

I hope this helps, and good luck with your taper plan. Be safe. (BTW, I haven't ever really had any problem taking a benzo with bupe. As long as your tolerant to the benzo, you should be ok, and the general rule is with the benzo+opiate is divide either dose by 3. So if your usual dose of xanax is 1mg, take 1/3rd of the pill with the opiate.) Again be safe, and I am glad you asked about the drug combos before just doing it THEN asking about it.