Opioids Suboxone

[plumbus-nine]

I personally never understood the chemistry behind Suboxone. It's an opioid agonist and antagonist rolled into one, so you're basically half high and half in withdrawal.

I would rather either take Naloxone alone, or taper myself off with a weaker opioid.

There are three subtypes of opioid receptors (and sub-subtypes), mu, delta and kappa. Mu is the primary one which mediates the effects of opiods and many opioids are selective for mu. Buprenorphine also antagonizes at least kappa, if not delta too. Blocking kappa seems to have beneficial effects as it gets activated in times of stress and addiction and mediates negative emotions (very simplificated). Also on the mu, buprenorphine is only a partial agonist. This causes precipitated wd when one has a full agonist in his/her system which gets displaced by bupe (it has a strong affinity to mu) and there is a sudden reduction of mu activity.

Bupe alone doesn't keep you in withdrawal, there is an initial adjustment period due to the change from full to partial agonist but thats it, and over after some time.
Naloxone is only in there to deter abuse (with routes like nasal, iv etc. its bioavailability is much higher than the few percent with oral dosing). It also lasts only a hour, so isn't a good candidate for ultra-low dosing like people do with the cousin naltrexone. Never tried it but many says it works against tolerance.

 

[MadHatterMike]

I have for over 10 years first Suboxone strips then tablets then the Subutex football shaped ones then the generic Subutex the last several years at about 32mg to 40mg a day..waaaaay too much and the last month I've been off of them it's a longer process of withdrawal than most of anything and worst part is because of the blocking of bupe can't find nearly any relief from anything.. mentally anyways but physically the Imodium helps. I stopped on the 12th last month and still have blocking going on so nothing will get through.

 

[MuertaMan]

Can you get any gabapentin or Lyrica?

 

[Man67]

Well, I took a third of the 8 mg strip last night & I got an unexpected surprise of a light euphoria & complete pain relief. And the euphoria even lasted a lot longer than Oxy ever did! I also slept like a baby, & with good dreams rather than the bad ones I’d been having. I just took 2/3rd’s off the strip. I’ll see what happens there. I’ll let ya know!

Unfortunately that euphoria will gradually dissappear. Been there, done that. Your opioid tolerance is supposed to be lower after Suboxone treatmenthttps://www.bicyclehealth.com/subox...e regularly will likely,and go back to normal.)

 

[Man67]

Well, I took a third of the 8 mg strip last night & I got an unexpected surprise of a light euphoria & complete pain relief. And the euphoria even lasted a lot longer than Oxy ever did! I also slept like a baby, & with good dreams rather than the bad ones I’d been having. I just took 2/3rd’s off the strip. I’ll see what happens there. I’ll let ya know!

Unfortunately that euphoria will stop over the time. Been there done that. After a longer Suboxone treatment your tolerance for opioids should be significantly lower: (https://www.bicyclehealth.com/subox...e regularly will likely,and go back to normal.)

 

[MadHatterMike]

If it's Suboxone with naloxone this may be true but I'm having a different effect after using the Bupe by itself for most of the 10+ years on subs..now I'm thinking maybe it's my tolerance that's outta wack bad. I've only been off of em just over 2 months now but I can't feel half dozen hydros. However it could be the receptors still not working right since I can tell from the classic eye test they are doing something just can't feel em at all.

 

[FunkieJunkieMonkey]

Well, I took a third of the 8 mg strip last night & I got an unexpected surprise of a light euphoria & complete pain relief. And the euphoria even lasted a lot longer than Oxy ever did! I also slept like a baby, & with good dreams rather than the bad ones I’d been having. I just took 2/3rd’s off the strip. I’ll see what happens there. I’ll let ya know!

Hey Blinky7766,
I’ve been a regular opiate user (and abuser) off and on for thirty five years. Just came out of a five year heavy duty oxycodone relationship. As soon as the withdrawals set in I knew I was screwed. At my age, it’s brutally different than when thirty or forty. Anyhow, my primary (who was prescribing the oxys like a pez dispenser). told me she no longer felt comfortable writing me up for opioids. Of any type. So I started the entire freak out that is an addict realizing they’re an addict. Gobbled some Kratom, Imodium, Benadryl, Hydroxyzine and a couple clonidine I had on hand just in case this happened. Then I started reaching out to people. A very dependable, reliable and honest friend suggested BicycleHealth.com. He had dropped a heavy dope habit, that was also a fentanyl habit. True blue Fucked. He called the place, arranged a call back, was enrolled in a program by nightfall. Next day, he had been assigned a prescribing Dr, did everything virtually through his iPhone, she sent over some Suboxone and “comfort” meds as well to ease the transition. Zofran, clonidine, ibuprofen 600’s and a couple others. Within three days he had a treatment plan in place, a mental health professional he requested, group meetings and the Doctor has kept him in adequate supply of the subs. Saw him last week to say Hi and he was doing great. Best I had seen him in years. Sooo, I figured I’d dive in the pool as well. My experience was not identical but very similar and I haven’t used or abused an opioid since (I’m taking the subs exactly as prescribed) since my enrollment). The comfort meds really helped a ton, my assigned Dr is a very very chill lady who knows her shit. My therapist is a Badass and I’m going to sit in on a group session end of this week. And I never had to leave my home, job etc because it’s all virtual. They’re licensed in like 32 States and accept a long list of insurances including Medicare (and offer a payment plan if needed) —-> so if you’re legit dead ass serious about coming off any opium derivative, I’d honestly give them a buzz buddy. Can’t hurt to call or visit their website. Good luck. Much Love and Respect, FMJ

 

[edika]

I have 4mg dissolving under my tongue as I write this, so I now take the job as the designated expert (professional) on this subject (I don't get paid for this job, so any donations would be helpful)
jk I'm no expert.

The thing with Suboxone is you MUST wait until you are in bad withdrawal (or moderate depending on how the doctor doses you) to begin taking it, otherwise taking it is going to kick you into what's known as Precipitated Withdrawal, as mentioned by plumbus-nine at the top of this page. Precipitated Withdrawals can send you straight into the worst possible withdrawal symptoms a Human being can possibly experience. For example, what would've been your normal natural hellish withdrawals now becomes 2-3 times worse multiplied, due to the presence of Buprenorphine (if you don't start at 2mg and work your way up as now all good doctors will do, starting small will avoid multiplying the withdrawal if you take the Suboxone too soon into your withdrawals). This is due to the presence of a remaining quantity of opioid of abuse still remaining in the receptors when you take the Buprenorphine. You know you've hit the right moment to take Suboxone when you are in the heat of withdrawal and you're sweating and you have intense anxiety and you just can't take it anymore. Doctors say this is 48 hours into your withdrawal. Either way, the good doctors will start you with 2mg, and work up to a point of either you are beginning to feel the precipitated withdrawal and you must wait a 1-2 days while taking a smaller amount and then eventually work up to reach your target dose, or you will be totally fine and you will work up to your target dose on day 1. Also, if you swallow the tablets by accident, the Naloxone will become activated, and you will be into withdrawal. Otherwise, dissolved under the tongue, Naloxone is inert and will not become activated in your system. The doctor told me it's okay to swallow the saliva that remains in your mouth after dissolving, but I, out of fear, spit it out when it's done dissolving. I guess I just have a natural fear of Naloxone. Maybe it's in my genes. Maybe it's Maybelline. Maybelline aside - at least you can feel like a normal person and a human being on this stuff.

Other than that, it's great!

 

[Man67]

H

If it's Suboxone with naloxone this may be true but I'm having a different effect after using the Bupe by itself for most of the 10+ years on subs..now I'm thinking maybe it's my tolerance that's outta wack bad. I've only been off of em just over 2 months now but I can't feel half dozen hydros. However it could be the receptors still not working right since I can tell from the classic eye test they are doing something just can't feel em at all.

How long before you feel normal again after your last dose of Suboxone (0.25mg)?

 

[MadHatterMike]

At that small a dose maybe not too long..possible a week or two if you only used it at that dose for a few years or less. However for me after 40mg a day or more snorted for 10+ years I'm still not near normal after over 2months now..I did a small taper a week or two maybe to 4mg to about 1-2 mg a day for a week then the last day 6mg jumped off..had the opportunity to get hydros which was my plan to switch after a week of nothing so I ended up jumping at 6mg. The first several weeks are awful for energy..first week is the worst for restless leg and sweats and cold..and overall withdrawal.

 

[Man67]

At that small a dose maybe not too long..possible a week or two if you only used it at that dose for a few years or less. However for me after 40mg a day or more snorted for 10+ years I'm still not near normal after over 2months now..I did a small taper a week or two maybe to 4mg to about 1-2 mg a day for a week then the last day 6mg jumped off..had the opportunity to get hydros which was my plan to switch after a week of nothing so I ended up jumping at 6mg. The first several weeks are awful for energy..first week is the worst for restless leg and sweats and cold..and overall withdrawal.

I used 8mg for almost a year and then suddenly all possible side effects appeared overnight. I couldn't figure out what's happening. After being miserable (mentally and physically) for almost a month I decided to tapper down. When I got to 2mg I reduced the dose by 0.25mg every 3 days. I feel better since I started tapering which doesn't make any sense?! Hopefully next week I will finally be free.

 

[MadHatterMike]

Well bupe has a sedating side effect for a lotta people and when on a low dose you can actually feel a slight euphoria or feel good at least. Maybe that is what's happening also that's good that your dose is that low and only a year or so on them..just remember even at a low dose you will have some withdrawal it's unavoidable but should be less severe I think at a low dose like yours. But everyone is different..I wouldn't recommend stopping at a higher dose like I did around 6mg last dose even though some say that is one way to taper actually at the end which idk how that's better.

 

[edika]

Well bupe has a sedating side effect for a lotta people and when on a low dose you can actually feel a slight euphoria or feel good at least.

I believe (without doing any research on the matter lol) that at dosages of 2mg and 4mg that Bupe has a higher affinity for the Mu receptor, and there is a lot more pronounced euphoria (at least there is for me). When I take 2mg or 4mg it doesn't feel like it's enough to curb my withdrawals, but the second I hit 4mg (I am prescribed 2mg tablets and I 'climb up' to my dose each day) I notice that's some sort of a sweet spot for cognitive function and euphoria, and I'm looking forward to getting down to those doses because I feel like taking Bupe at 6mg or higher is overloading my receptors somehow. So many other weird side effects start appearing the instant I get past 4mg and get to 6mg, such as a marked dissociation and I start having intense cravings - almost like my Mu receptor was 'having fun' at 4mg and then suddenly with 6mg 'party's over!!' and the euphoria is much much less pronounced, and the sedation takes precedence. But that's simple conjecture and heresay from what I've observed only in my own brain so there obviously are other factors to consider.

 

[Keif' Richards]

Thank you so much for your reply. I was thinking that the Suboxone maintenance program inevitably lead to withdrawal, so I’d would be trading one withdrawal (oxy) for another (suboxone). But you’re saying that if I’m in a suboxone maintenance program I will not have a withdrawal at the end of the program? Is that Right? Also, do you know if my primary care provider has to sign off to give me permission for the Suboxone program or is it the Doctor Who runs the program who signs off on it?

I think you misunderstood me. You would be replacing your current Opioid for another. There is inevitably going to be discomfort in the process, but it doesn't have to be severe. If you are sober, doing well and all of that. You can revisit the idea of abstinence from Opioids from a place of physical and mental stability. You can make the tapering process as long or as short as you want it to be.

You're question regarding the law and such is going to vary from state to state. In many places i.e. East/West Coast and larger urban areas often allow prescribers to write a prescription. This would normally be in violation of the Harrison Act. Laws are changing every day, so always keep up with new things in your area.

Nine times out of ten you're GP will refer you onward to an addiction-relate provider.

I know there are even mail-order services that do Buprenorphine (Suboxone). A commone practice where I am is for a patient to report to the ED then get shuffled into the necessary long-term program from there. They will typically hand people a three day supply of the drug with the implication being they schedule you a follow-up that you must attend to maintain the prescription.

At any rate, it is not difficult to get and the wider medical community seems to be okay with liberally prescribing it. For instance, Buprenorphine does not have street value in my neighborhoods in Massachusetts. Everybody has them, everybody wants to sell them... etc. If you're choice is to pursue maintenance, you have many options.

 

[Biggdogg88]

Hey @Binky7766

I think I can help you out a little bit. Hopefully some others will chime in and get you some variation.

Buprenorphine (Suboxone) has never struck me as being harder than any other Opioid of proportionate dosage to withdraw from. A lot is often said of how difficult it is to withdraw from Opioid maintenance, which would include Methadone but I think the biggest issue is surrounding the nature of maintenance itself. You give someone a perpetual prescription to an Opioid and put the ball in their court. It can make it pretty difficult for a person to break away from permanently.

I think there is also something to be said for the long-acting nature of these drugs. I believe this also comes into play. The fact that the withdrawal experience is a more protracted experience can really change how a person feels about it. Me personally, I always found it easier dealing with the longer withdrawal phase, but this was me taking gradual, intentional drops and not me getting thrown in jail to do the whole thing cold-turkey. Yes, if you ask me, doing Methadone or Buprenorphine withdrawal combines the worst of all worlds, psychological, phsysical and spiritual, so I'd advise against that. If you do the right things and don't take risks, you shouldn't have to worry about this outcome. If you're the type of person for whom this eventuality seems possible, yea, maintenance might not be in your best interest.

Maintenance is best for people who are willing to take all the steps necessary to get better. An addiction is not over once the withdrawal has ended. I'm not going to overload you with rhetoric here regarding sobriety. Take these words seriously though.

I think going on a Buprenorphine taper could be the right thing for you. It would be a way of taking measured drops in your toerance without having to worry about the often erratice nature of self-medicating with Opioids. You can go, get your dose once a day or once a week and start working on the issues that are contributing to your addiction. If you play your cards right and engage in the entire process of getting better, you could be successful and be free from all Opioids at the end of 3 months.

If you have any other specific questions let me know.

Wow that is a really good way to look at things. If you use street opioids you can get locked up and thrown in jail and be forced to go cold turkey, but with suboxone you won’t have to deal with that.. wow this guy is on to something so simple but ingenious.. and if you can’t deal with the suboxone withdrawal, just take another perc right? Hahaha jkjk

 

[MadHatterMike]

Well after 3 months off subs I ran outta kratom and couldn't find tabs so I ended up taking Bupe again two days in a row now..got a headache from it and nods but I'm mad at myself for restarting the withdrawal after 3 months off and being done with the physical withdrawal part. Shitty thing is even after the 3 months off bupe I still couldn't feel any opiates at all..

 

[Ron123]

30-35 years on Bupe.
My Dr would supply as many tablets as I wanted as long as it was under 24 Mg per day.
Then the rules changed. New state new rules. New Dr wanted me to take Bupe + Nax. That did not work out. At all.
Finally went back to the highest dose he allows which is 6 Mg per day.
I only need 4. So 1 tab goes into my backup stash. You never know sometimes shit happens and you can be left without meds for weeks or months.
A typical senario. A new company wants to enter tha market. But there are already 3 companies making the drug.
So what they do is bribe the Drug Control to raid these 3 guys. And have them shut down. The logic given is 2 guys were supplying more salt than on the label. i.e. 2Mg tabs were found to have 3mg.And the other guy was supplying less i.e. 2mg tabs only had 1.5 Mg. Its all big money politics.
If your not feeling well on bupe. It normally means you took too much. I say start with .2mg and stick to the lowest dose you can.
Also I found that the longer you put off taking your first dose for the day the better it works. These days I can get to 2Pm before I take my first dose.

 

[AlsoTapered]

I was supposed to take 8mg at one go and the anxiety was untenable so I bought a pill-cutter and too 2mg [QID]. The lady at the HR place said 'do whatever works' and after 7 days I just stopped... and didn't take ANY opioids at all until I was prescribed them for pain (which is why I had been taking opioids in the first place!).

 

[MuertaMan]

Well after 3 months off subs I ran outta kratom and couldn't find tabs so I ended up taking Bupe again two days in a row now..got a headache from it and nods but I'm mad at myself for restarting the withdrawal after 3 months off and being done with the physical withdrawal part. Shitty thing is even after the 3 months off bupe I still couldn't feel any opiates at all..

You still got the poison out of you for 3 months so you arent starting completely over don't be too hard on yourself.

 

[MadHatterMike]

Well I went back to the doc to try to get naltrexone but she went on and on glossed over anything I said and put me back on bupe. So I've been a few days back on a few mg a day..I'm sick of this crappy medicine and been wondering for years about switching to methadone. Does anyone know if it's possible for doctors to put you on methadone if your coming off bupe ? I looked up the info for a clinic that does methadone along with other stuff like bupe and naltrexone treatment. And is it a daily deal to get doses forever ?