Bupe Transitioning from Loperamide to Subutex, concerns re precipitated withdrawal.

[ophelia-artaud]

I am a 9 year heroin/ buprenorphine/ Loperamide addict, rotating between those 3 with regularity. Seeking some advice/ clarification on safely transitioning onto Subutex after approximately 1.5 years on Loperamide (96mg 2x/ day). My last dose of Loperamide was Thursday 10/17 at 5am. It's been 8 days, tomorrow will be the 9th day off Loperamide. I've been doing heroin for the last 8 days instead since it is easy to transition onto Subutex with it and I have a lot of experience doing so.
My concern is precipitated withdrawal from whatever Loperamide is still in my system after 9 days. It has a LONG half life- I read that after years of dosing insane amounts it could increase the half life to 72 hours. I've also read a case of precipitated withdrawal after one week off of Loperamide on this site. Will I be ok to wait my usual 18 hours from my last heroin dose?
If you're wondering why I'm making this transition, it's a combination of health & financial factors. I would be grateful for ANY insight you can give me, because I'm pretty scared right now. Precipitated withdrawal is downright traumatizing and I don't want to go through it again.

 

[JamesB1985]

Been through precip 4 times...i don't have much experience with loperamide though. The best advice I can give you is to go by WITHDRAWL SYMPTOMS. Not by time.
Use the COWS( Clinical Opiate Withdrawl Sheet) to judge your symptoms. Make sure your in at least moderate withdrawal.

 

[negrogesic]

This is an interesting scenario.

200mg a day of loperamide is a hefty dose (and a dangerous one as well -- QT prolongation, ventricular arrhythmia resulting in death, etc.).

I used loperamide to get off of high dose tramadol, and wound up on it for a fair amount of time. Never exceed 80mg a day though. Never felt properly high but I certainly felt those higher doses. Though i tapered off, when i finally stopped i could definitely feel withdrawal symptoms for a month, so clearly the half life is long.

Id recommend tapering off of loperamide instead of getting locked into buprenorphine (unless you aren't ready to stop opioids entirely).

Stick it out further till you start the bupe. Maybe even get some kratom to allow yourself to get as much distance between the loperamide and bupe.

That said, you might be in the clear to start the bupe already. Another strategy might involve having a shot of heroin ready just in case you do experience precipitated and use it if needed. This is a messy approach and not recommended.

Something like kratom might allow you to get some more days in between, without setting you up for precipitated withdrawal.

Out of curiosity, did you feel high from the 200mg of loperamide? What are high dose loperamide withdrawals like?

 

[ophelia-artaud]

That said, you might be in the clear to start the bupe already. Another strategy might involve having a shot of heroin ready just in case you do experience precipitated and use it if needed.

Sadly this strategy wouldn't work. Once the buprenorphine starts clinging to your receptors it won't let the heroin do it's thing, even if the partial agonist action is resulting in a feeling of severe withdrawal. I know because I tried it! Shot did nothing, I just vomited.
But to answer your question- 96mg 2x a day could occasionally give a slight opiate buzz, but for the most part you'd feel nothing. The withdrawal, however, is exactly the same as heroin withdrawal and can be extremely intense with the type of doses I would take. I was locked up in county jail in a county where they gave no meds at all, unlike my home town which doses inmates with Suboxone and Librium. 48 hours in I wanted to bash my head into the wall with the hopes I might go unconscious....
I just dosed 2mg Subutex so ill let you guys know how it works

 

[ophelia-artaud]

In the hopes that it will be beneficial to someone in the future that might be transitioning from Loperamide to buprenorphine, I'm sharing my results.
At 10am, 21.5 hours after my last heroin dose I dosed 2mg Subutex sublingually. 1hr later I felt slightly better. It is hard to tell because I'd been consuming a lot of lyrica (600mg) and Clonazepam (2mg) for the withdrawal. So about 4 hours later I shamefully injected 1mg Subutex. I felt 75% better. I did inject another 1mg later in the day. I didn't intend to IV the pills and yes I know how bad shooting pills is, my veins are hard plastic because of injecting Suboxone films. Literally turned my veins into plastic.

No precipitated withdrawal. Now my struggle will be heroin cravings since I just binged hard for a week. But anything is better than Loperamide... I'd have ended up in a hospital sooner or later if I kept it up with that. I hope this helps someone out there: wait over a week, in my case 8-9 days, to be safe from precipitated withdrawal.

 

[Painful One]

Good job Ophelia! ❤

I know how bad the withdrawal from loperamide is. I foolishly used too much for too long and almost couldn’t get myself out from under it. I went through 6-8 weeks of SEVERE withdrawal from Loperamide. It sucked SO bad!

I am happy to see this thread as I have seen many, many others who have asked this very question and I had not seen an answer until now.
Good on you!

Your health will improve and I am so glad you stopped the loperamide before something really bad happened.
So glad we didn’t loose you!

Be well!

 

[Lucy20]

A drug is out of your system 5x the 1/2 life

 

[Keif' Richards]

There is not a lot of data surrounding the issue at hand. Loperamide (Immodium) as an actual maintenance/recreational drug is still relatively unknown and hence unstudied, I have a significant fear that you are going to experience PW if you don't taper the Loperamide first. This is just a guess, but it is an educated one and I don't want anyone to have to endure that hell if they don't have to.

Luckily, Loperamide comes in low-dose tablets that allow for fairly straightforward titration.

 

[negrogesic]

Good job Ophelia! ❤

I know how bad the withdrawal from loperamide is. I foolishly used too much for too long and almost couldn’t get myself out from under it. I went through 6-8 weeks of SEVERE withdrawal from Loperamide. It sucked SO bad!

What dose were you taking?

 

[Painful One]

What dose were you taking?

I took about 70-80 mg a day for a twelve day period to bridge my prescription and I ended up having to go through 6 weeks severe withdrawal. It took about 8 weeks to get stabilized again on my regular pain medication. The loperamide jacked my tolerance up, big time. That was a few years ago.

 

[kinkyjohn]

I can't imagine the lope will be a significant part of what's keeping you well at 8 days .. but it can be really personal with these crazy long half life drugs. The half life for you could be much higher or lower than the stated one and who knows how it interacts with heroin. I will say though ..that the precipitated WD almost certainly won't be that bad now .. not like it would have been if you hadn't waited 8 days plus it's over in an hour or two (keep taking 4-8mg bupe every half hour .. it should go in an hour or two). I've had similar things with fent .. it's an odd drug for causing precipitated WD at 24 hours despite it's 4 hour half life. The precipiated WD at 16 hours isn't much worse than the WD at that point but the one at 0 hours is fucking crazy (think puke till you choke then lose your mind to the pain). One warning there .. my concept of "bad" withdrawal doesn't exactly fit on the COWS scale. Obviously .. if you still feel well at 18 hours off H and you take bupe .. get ready for the crazy WDs.

There's also the bernese method but that'll be hard to do at home and is obviously not cheap. I tend to snort very tiny doses (~0.2mg of bupe every 45 mins) repeatedly and don't wait at all since my final dose of full agonist and get no precipitated WDs .. but you REALLY shouldn't be doing that if you fear the precipitated WDs as that is proper lab rat off label bupe use. Just make sure you have no full agonists around when you switch to bupe so you don't do anything dangerous. The mind doesn't remember pain well (you don't have to relive painful experiences each time you remember them do you?) .. you'll get through it.

Best of luck! being dope sick fucking sucks.

 

[Painful One]

Kinkyjohn,
You had me cracking up on the “proper lab rat off label use” and at the thought that your idea of bad withdrawal does not exactly fit on the COWS scale. LOL! So true eh? Same for me.
love your user name as well. Heheh.
Thanks for the laugh.

Ophelia,
How are you doing sweetie? I hope all is well and you are feeling better.