Suboxone misinformation for long term users with high tolerance

[Lydian]

Hi all,
First off I'd like to say that I've been a lurker on BL for over a decade and think it's a great tool to share information and experiences on subjects that are often too taboo to discuss in normie society. That being said, I recently was put on suboxone again for the first time in 10 years after an awful precip experience trying to switch from high dose methadone (waited 72 hours...still worst WD I've ever had in my life). Before getting put on subs, like many of us, I had poured over countless forums and posts about their suboxone induction stories and the general consensus that more is less, due to more norbupe etc, and also how subs should instantly take WD away if you wait long enough and score 26 on COWS. So I go to the doctor after a looong term opiate addiction, 14 years heroin/methadone/oxy, all at incredibly high doses as you can imagine after building a tolerance that long. Well, I had stopped using methadone several months before, I know that it can store in bone marrow and fat, but for all intensive purposes it was out of my body before people cry methadone. I had been using about a g of H for the subsequent two months up until the point I go to the doctor. When I take my first sub I waited 36 hours, violent vomiting and diarrhea etc, and start out dosing 2 mg at a time every 90 min...well after 6 hours of taking the subs I was in terrible withdrawals and due to the length of time I'd waited it definitely wasn't precips. As with most addicts, I'm freaking out since I thought I'd get relief, and go get a bag....and I feel it great, only 7 hours after taking 8mg bupe. I continued using for several more days until I ran out of money and felt a sense of hopelessness that if subs won't work then I'm royally fucked. So I wait till I'm in WD again to reinduct, same thing happens...awful WD and no signs of improving. I went through terrible WD for 5-6 days WHILE on 6 mg subs a day, though by day 4 improvements started happening...the whole week I didn't sleep for more than 10 min at a time and I'd wake up shivering covered in sweat, and of course eating off the table. I'm 2 weeks of dope now and feeling fine but the first week was hell and I tool the correct steps to make the transition that seemed to work well for countless people, go as seamless as possible...so you might be wondering, this guys gotta be full of shit I took 1 mg of subs and felt great. Well from what I've gathered I think this is what happened.

So, first of all, all of the people who seemed to find instant relief from subs, or at the very least were in minor discomfort for the first few days while transitioning didn't have anywhere near the length and volume of opiate use I had (for several years taking several hundred mg of methadone at a time, several hundred mg of oxy too etc). Yes, bupe is very powerful but it's only a partial mu agonist and from the information I've gathered has a ceiling effect similar to 30-40 mg of morphine...so when your mu receptor are used to the full agonist activity of a several hundred mg of methadone for over a decade, 30-40 mg of morphine won't even begin to touch your WD, let alone break through enough to relieve WD completely as countless people seem to naively suggest.
So tying this all back into my story, the ceiling effect wasn't nearly enough to alleviate withdrawal symptoms, very minor improvement. I saw so many posts where people were going through similar situations, maybe not to my degree due to my embarrassing degree of overindulgence for 14 years, and they kept getting the same useless responses by people that either don't understand these processes or they couldn't imagine people with tolerances so high that subs didn't work right away, I mean after all I took 2mg subs and felt great "less is more"...yes that's true for norbupe but due to downregulation? and BDNF...people with bad lengthy habits that require more due to desensitization. I'm not endorsing 24 mg which my doc has me on, but the 1-2 mg a day maintainence dose that I've seen thrown around so much might not be wise for certain people. And all those poor souls I've seen posting frantically for help because they did everything right and the subs aren't helping, then people keep saying "you took it too soon you need to reinduct and wait longer" so they have to go through more BS, that might be true in some cases but not all. As many people have stated, subs aren't a miracle drug, just a tool; and for those with a tolerance and usage history similar to mine, subs my alleviate some of worst WD symptoms but it's not gonna be easy by any means, but over the course of a week as your body is adjusting to the lower activity from subs on the mu receptors you're gonna feel awful, but of course it does get better but just realize that if you've over indulged as I did you're gonna have to pay the price if you want to use subs to get off your DOC...but if you plan on being medicated for the rest of your life and can't handle bad WD, maybe methadone is the way to go...though imnsho, methadone is the worst of the worst as should only be utilized as a LAST resort and you've exhausted all other options.

I am by no means an expert in these biological processes, just my 2? for harm reduction, so for those who have a complete grasp of these subjects, feel free to correct me. I'd be happy to have a discussion and be educated...also sorry for the novel, I wanted to be thorough to avoid answering questions later due to lack of information...thanks.

 

[Pickledlemons]

Yeah, it sounds like subs are just not strong enough for you. I know my doctor prescribes morphine to people with really high tolerances, then tapers them down to a safe - lower dose and then switches them to subs. I've also heard that people taking methadone who want to switch to subs have to be taking 30mg or less for the subs to work. So if you were taking 100+ mg of methadone, and then maintained that same level of tolerance with heroin... Yeah I'm not really surprised subs didn't work.

Also, subs do have a ceiling dose but it is WAY higher than 40mg of morphine. Way higher. WAY higher.

 

[Lydian]

I'm not seeing my reply so forgive me if this doubles.
I've seen the 30-40mg mg equivalent thrown around in a couple posts but I can't verify their sources. If you're only looking at conversion charts then 60 mg Oxy = to 2 mg bupe...and for those with experience in both, even someone without a tolerance I think they'd have trouble seeing the two doses as equivalent. If you gave someone with no tolerance 2 mg bupe vs 60 mg OC, they're gonna get significantly more rocked from OC. Since bupe is a partial agonist and has weird as fuck properties in general, I think those conversions should be taken with a grain of salt. I know for me, I'd get more relief off 60 mg morphine than 1.5 mg bupe. That's of course anecdotal but something I'm confident is true for my body n habit. Not saying they're not great tools, after all I've been of shit for 2 weeks which is a miracle for me.

 

[Pickledlemons]

Yes you are right, it is difficult to convert doses with a partial agonist. The suboxone ceiling is around 32mg.. which according to a dose converter is 2400mg morphine. I was going to include that in my original post but did not for that exact reason.

Just because 1mg of sub is equivalent in potency to ~50mg of morphine, doesnt mean it will get you as high as 50mg morphine. Its a tricky conversion because the effects are so different.

So yes you are right... still 32mg of sub is definitely more than 40mg morphine.

 

[Lorne???]

Unless you are injecting the morphing, that is BS- would rather have 8mg of Bute than 100mg morphine PO(probably, who knows?) anyway 300mcg= rougly 10mg IV morphine m, at least in analgesia, though it is near enough; and 40mg of ~chronic~ methadone is equivalent to nearly 200mg morphing PO-

A lot misinformation in your post OP, no time or inclination to go into it, however it is down regulation and altering of activity that cause tolerance and opioids to have different effects over time, as they can, reverse in a way, however if you really needed over 100mg to suppress wd Buprenorphine transition needs to be handled differently, and frankly, ?hundreds of mgs of methadone seems like bs or D-sizing, and a quarter gram or more can cause long q t syndrome and no one in there right mind would give that much, and you would have to be rich to buy that much - not calling you a liar, just putting that out there

 

[Lydian]

I've edited the post and will re edit it if you have time to chat. I've tried to edit a post and it keeps getting deleted? So basically it's desensitizing the receptors, and after such long usage they became so desensitized that bupes were of little help for the first week. Also I wish I was lying about the volume of usage, being in a clinic plus street md...had tons of money (especially for someone my age) but not born rich...I know there's specific rules on sites like BL as far as incriminating info so you can guess how I could afford such a big habit. Also it seems like you have a good grasp on this, looking for info on BDNF and it's relationship to opiate tolerance and dependency. Thanks for the replies.

 

[Lorne???]

Nah, incriminating rules are pretty relaxed here; no pricing no sourcing, and HR first

Anyway, post any questions, and will answer then if can myself or others, and can always dig info up

Occupied atm and not feeling very good

Good luck with suboxone, check the Buprenorphine megathread for general info, and the induction process and dosing, etc

"Less is more" is generally true, however some people need high doses- and norbupe isn't really the reason, no time to go into it, it is complicated and not full elucidated however there are many factors in play, and nor bupe, well buprenorphine is almost entirely converted to norbuoe and conjugates(?) point is, taking Suboxone/buprenorphine by nought is useless, because of like 5-15% BA%; well, that other 80% doesn't just disappear; a large portion is metabolized into norbupe during first pass; if we assume 10% of a buprenorphine dose is absorbed into circulation, and say, 40% becomes norbuprenorphine(some sources state/imply that MOST of a buprenorphine dose PO is converted to norbupe because of first pass, however 40% seems reasonable enough for an unknown figure) well that leaves us with 4x as much nor buprenorphine compared to buprenorphine itself; that should mean you get the alleged full agonist effects; yet it is universally agreed (AFAIK) that taking buprenorphine by mouth is completely pointless/ineffective; this combined with norbupe apparently having trouble entering the CNS and some studies showing less analgesia with high doses(compared to buprenorphine) pretty much destroy this theory; norbupe seems to have little effect, and by itself sometimes no effect-

Thought would add that; the norbupe theory does not seem as hyped now though some still cling to it

Wish me luck, Lorne (don't incriminate yourself to much, yet don't claim your pet cat decided to try Rohypnol on the rocks) - and - WELCONE TO BLUELIGHT, as a member, and use site as necessary and feel free to post or even PM problems/questions

 

[Lydian]

Thanks for the response Lorne , hope you feel better.
Well the if the rules are relaxed I suppose I can share how I was able to balloon my tolerance to a pathetic level because it's fairly interesting.
Well I started opiates at first when I was 14 (heroin/oc) and pretty quickly became dependent. At those times I would get rocked off a 40, and would often joke with friends about what it would be like to have a popcorn bowl full of 80s to take at your leisure...little did I know less than 12 months later I'd have exactly that. Through an acquired I met an older crackhead who said he goes to 3 doctors but couldn't pay for his doctor visit or his script n offered me 1/2 if I'd put up the $$. This was in the latter half of the 2000s when doctors gave out opiate scripts that seem like fairy tales by today's standards, nevertheless, one script would yield several hundred 30s 40s n 80s , lol I know it's funny doctors felt the need to prescribe 3 of the same thing for "break through pain". So I did that and it worked out and as I said he went to 3 doctors all getting huge scripts...oh yes also with all the scripts of oxy, the docs also wrote 120 methadone wafers a month...like OMG who on earth could take that and not die the first day with no tolerance. Nevertheless things worked out with him and it turned out he had several friends who were in same boat, going to multiple doctors but too much of irresponsible crackhead to pay for it themselves , so naturally I did...I had begun selling what I didn't use to pay more the influx of appointments too. When this really started getting crazy I was only 16-17 and missing tons of school every month to take them to their appointment, a total of about 12 a month n I would sit in waiting room with all of them n the doctors and nurses never approached me once like who the fuck is this little ass kid with all these adults. So I got 1/2 their scripts for 12 visits a month, each script was a fucking gold mine too. So as I said , I had been selling what I didn't use and quickly accumulated 10s of thousands over 2 years which is ton for a teenager, and as a teenager I lacked the healthy fear of addiction I have now and ended up taking handfuls of 30s at a time 12-13 and would get high but not very long. This continued till I was in my early 20s n one by one the doctors started to go to jail or stop seeing pain patients, n by this time a system had been put in place to make sure people weren't doctor shopping , so I wasn't able to sell anymore but was left with a huge habit. I ended up moving in with the first crackhead I met n his wife n they still saw one doctor a piece so I was able to manage , but I ended up going to a clinic for md, getting on a huge maintenance dose n buying all the domes they got from their doc too, that went to shit after couple years when he died from OD and I was forced to turn to heroin and work a fuck ton of hours to support my habit. Which is what I did up until 2 weeks ago when I got off shit n on subs. N somehow by the grace of god or something I was able to get a degree in anthropology from a university while juggling this madness and don't have a record...which is a far cry from 1/2 my friends who are dead and the other 1/2 are either on their way to death or their lives are ruined beyond repair...so for that I'm grateful beyond words. I know it's long but that's about 13-14 years of bs lol .
As far as questions, in up regulation I think I was referring to BDNF, which happens in conjunction with down regulation? I'm really not sure but from what I've read it seems really interesting if anyone has insight into it, as I haven't really dove head first into the academic reading..which atm is the only material available on it. Thanks.

 

[Lydian]

Lol I just read what you edited about not incriminating yourself too much. PMing would have been better idea but I can't figure out how. If post gets binned hopefully you had chance to read beforehand lol. If you PM me maybe some notifications will pop up n point me in right direction. How you dealing with the sickness?

 

[Trabbamab]

Maybe I am just an oddball with a fairly high tolerance to buprenorphine for some reason but I have never felt anywhere near what most equivalency listings have seen for Suboxone. For me, 4mg of buprenorphine feels roughly like maybe the first hours of 20mg of morphine IV, if that. The doctor who originally got me off of methadone and on Suboxone said I needed to reduce down to 30mg of methadone or lower before 8mg of Suboxone would work and he did not have good experiences with trying to go higher on that (such as 60mg to 16mg of Suboxone). However, this doctor was a Suboxone-prescribing private practitioner and I was going to the methadone clinic so there was little to no communication between the two so maybe take that with a grain of salt.

To the OP, I wonder if you are taking the strips effectively. After taking them for a long period I have found they are pretty finicky. The instructions say to wet your mouth before taking it. This has never worked well for me. Almost as soon as I put it in, I can taste a lot of the drug flowing down my throat as my mouth salivates and takes it into solution. Some I know have very different methods of taking it (I read someone talking about even dissolving it in water first and they swore by that method), but I actually take it when my mouth is extremely dry and just clamp my tongue down hard on it for sometimes 30 - 45 minutes until it disappears. At no point do I feel saliva in my mouth. And that does the trick for me.

If you can get more, maybe you just need to experiment and see what works for you. There doesn't seem to be any "best way". Unless you are doing 20+ bags of heroin a day, a dose of Suboxone should be able to hold you. Heroin is always difficult to talk about and measure though due to its unknown purity and dosage. But if it helps at all in comparison, I know people who moved from 150mg morphine a day and ~220mg of oxycodone who were able to stabilize on Suboxone and make it work (I think both of them ended up starting on doses higher than 8mg, however, which is understandable). If you are familiar with the effects of those drugs maybe you could use that to compare your heroin habit. If you feel like you are near that or above you may want to consider seeing if you can get on methadone and then tapering that down to then change to Suboxone. That is the most common way to handle extremely heavy habits because methadone doesn't have the same ceiling effect that buprenorphine does.

Best of luck with it and post back if you need any more help!

 

[Lydian]

Hi trabbamab,
I know what u mean about wetting ur mouth beforehand...seems like my mouth fills with saliva and decreases the BA. I've heard about using mouthwash before hand n I may try that. Although I was on extremely high methadone doses at several points over the last decade...when I switched it was from a g of H a day though it's really hard to judge the equivalent dose because at this point nothing got me high just made me not severely sick. Maybe switching to methadone first would have been less painless but, and I know it's cliche, I needed to go through the extreme pain I felt on subs for the first week to know I don't wanna do that shit again. I've had a million chances and next time I start using I may not be so lucky. That being said there's no need to switch back to methadone then to subs again because now 2 weeks later on subs, I'm relatively "stable" at 5-6 mg a day with only hot flashes and night sweets, yes they're very annoying but it beats full blown WD and being a junkie. I never let myself take more than 6 mg a day even when I was sick as fuck stabilizing so my body got used to a more manageable baseline dose so it's easier to taper down from...and with the half life of subs
..even though my body metablozies opiates fast as fuck..there's still plenty of on board dose in body to hold me over since ceiling effect is more or less 8 mg. Thanks for the reply

 

[Lorne???]

I wouldn't delete post- however we have a Dark Side forum for stuff like that, and a social thread, though that is an interesting story

To the above poster, if your doing "20 bags" get better dope-the money your wasting, man-not you personally know it was an analogy it's just, well H is different by region, however, buying a point, is, well, pointless(ha!) With that money invest in the good stuff if you can-got lucky with a hookup who's business took him to a couple celebrity's, still good dope should work- an actual gram of pure diamorphine is actually a pretty massive dose by most standards

Anyway, guess you are asking about BDNF and the mechanics of tolerance and the changes to receptors over time? You also know that there are 3 receptors-Mu, Kappa, and Delta and actually a fourth which is not well understood/studied. My is most important, however there is debate in the role of Kappa receptors, as oxycodone is selective to them, and buprenorphine actually acts as an antagonist at those receptors(Kappa)

Anyway, Jekly Anhydride would be better equipped at the explaining how opioid receptors become "reversed" for lack of a better term. And, personally don't mind this at all, however you need a question, and am just trying to clarify; if it's about induction c fine, if it is more about opioid receptors the OD forum may be a better place to have posted. If it is both, cool, just clarify, as technically random discourse isn't really a thread topic- it isn't a big deal, just something to keep in mind, although think you have a legitimate issue with switching to subs, you may need 30-40 hours of full wd, to drop tolerance

Yiu would be amazed at how low tolerance would drop if something happened and you went days without an opioid; of course it would be miserable, and with such a habit, there are legit medical concerns however you make it and you tolerance is down to a fraction - good dope, or a shot of morphine, it feels amazing

Well this has dragged on, any more specific questions ask away(about induction, especially, we can have a endogenous opioid discourse eventually) and -surely- someone will chime in; otherwise PM if needed, actually maybe will PM you; if you are on a phone, especially the wicked closed system of Apple, then some functions of the site won't work, at least in mobile mode; try switching to classic, otherwise check the notification at top if PM you, and you can reply

And am a bit better, making it another 4 days with little, if anything, is scary (my current situation can turn bad quickly)

 

[RocketFox]

Unless you are injecting the morphing, that is BS- would rather have 8mg of Bute than 100mg morphine PO(probably, who knows?) anyway 300mcg= rougly 10mg IV morphine m, at least in analgesia, though it is near enough; and 40mg of ~chronic~ methadone is equivalent to nearly 200mg morphing PO-

A lot misinformation in your post OP, no time or inclination to go into it, however it is down regulation and altering of activity that cause tolerance and opioids to have different effects over time, as they can, reverse in a way, however if you really needed over 100mg to suppress wd Buprenorphine transition needs to be handled differently, and frankly, ?hundreds of mgs of methadone seems like bs or D-sizing, and a quarter gram or more can cause long q t syndrome and no one in there right mind would give that much, and you would have to be rich to buy that much - not calling you a liar, just putting that out there

IDK about that... I was on 240mg of oxycodone for 3 years, but by the last year I was going through 4k+ mg daily, then heroin I ended up around 3g to start my day and another 10-15g throughout. To the point I'm no longer able to be treated even at UofM. Last time I went in they tried to put me under and apparently I went berserk and after ripping out taser leads multiple times they were able to bury me in people faster than I could break them. They had to run a paralytic and anesthetic wide open on a constant drip, only to find out I was fully aware still, just couldn't move. I had to figure out how to twitch what muscles I could in a kind of broke dick sign language. The conversation I heard was horrifying and the experience more traumatic than 3 years at war as a life flight medic. Hearing what I'd done. The doctor saying he'd never seen anything like that in 30 years. The nurse saying to another nurse "it doesn't matter at this point if we give him more fentynal. I just pushed another 1,500mg, but we already threw out all the protocols and he should be overdosed already. Now it's just a matter of what's going to fail first, his kidneys or overdose." I spent 3 weeks in a psychotic episode where they had to keep me maxed out on chemical restraints to stop me ripping off the physical restraints and pulling the intubation and lines out. They ended up stitching a line into my jugular after the 5th time. I had to go through that twice before they started me on Subs. And before you try to call bs, I can post the bank statements showing $3,500 withdrawals every other day. Or pictures of baseball size bags I went through in under 3 days. I'm on 24mg subs and was great until this 3rd week. I feel crippling depression suddenly. But OP sounds just like what I went through on a lesser scale. I was taking methadone around 100mg years ago for an addiction around 50mg oxy daily. Now I can't feel any amount of opiate in my system and can't be put under for surgery for example. To quote doctors, "even if we could give you enough medication and didn't kill your kidneys, you won't find a doctor willing to risk their license".

 

[OpiateKiller]

I agree I have never found the transition from heroin or other opiates to Suboxone to be easy. It’s always been a royal pain in the ass filled with intense suffering and pain. Let alone the intense depression of trying to be satisfied with a partial agonist when accustomed to something like heroin.

 

[Lorne???]

Huh? I am really fucking confused

Sorry about your experience, though I do not know what it has to do with my post

I was knot talking about people going through Grams of Diamorphine a day or Fentanly; my mother had surgery recently and due to her Benzodiazepine habit they could not put her under ; she tried to tell them, they ignored her and after 3 shots of 4-8mg Midazolam and basically said they would not risk themselves to give a fourth so she had to be awake while having a peritoneal abscess removed

And they thought 10mg Morphine would be enough (initially 5"4mg) even though she

Anyway takes A LOT of Suboxone/
Buprenorphine

Anyway was not at all talking about your situation and yeah would kinda like to know how you afforded so much dope ...