Treatment What dose of rectal buprenorphine would I need for this purpose?

[candidsurprise]

Since last October (so 6 months) I've been on buprenorphine, 0.6 mg intranasal twice per day. It's been working so well for my addiction. for all this time it's been stopping my cravings, stopping me from feeling dysphoric and also the nice side effect of almost eliminating my long term severe, treatment resistant OCD. Every dose for 5+ give me the pinpoint pupils and has these positive effects for about 6 hours after taking it. However Since about 2-3 weeks ago my nose has started to run after I snort the pill, and I've noticed that my ocd, dysphoria and cravings are very bad again and pupils don't get pinpoint anymore.

So I decided to switch to plugging my usual 0.6mg dose a few days ago, and all the benefits are back. Thing is my OCD is telling me that now I'm just getting addicted to bupe and will keep raising the dose to keep these positive effects. Is that true? I mean for those 5+ months I was getting the same effects everytime so doesn't that indicate that it's my nose running which has changed things? as in rather than the positive effects of the usual 0.6mg going away due to tolerance. The last thing I want is to keep escalating doses of buprenorphine to keep getting these effects, but I've been under the impression that I haven't been trying to get high per se, I've just been trying to feel decent despite my mental health issues.

Also how much should i take rectally if I want the same dose as IN, and how long do the anti craving effects last for in comparison?

 

[Crack'r]

It's hard to say exactly but I believe rectal you will get about 1/3 first pass liver metabolism, though this might not be the common wording. Basically, once absorbed about 2/3 of the blood will go to your brain where it can work and 1/3 gets diverted where it goes past your liver before making it to your brain where some will get filtered. It's been a while but I think this is right.

As opposed to intranasal where all of it should pass your brain first, just like sublingual.

Does it not work for you placing it under your tongue? You can also put it between your lip if you salivate a lot so it's stays in place longer. That or cover it with a little piece of paper towel under your tongue to keep any spit away for longer. If not opposed to sublingual I might have another thing you can try...

 

[pharaoh]

As @Crack'r asked, why not use it sublingually as is designed? AFAIK it is the best ROA and is highly effective. Snorting is too ime but that was more to get some kind of mild rush, but I can't see any reason to take it through rectal administration unless you have a problem with your mouth or gums or whatever. I would be worried about wasting it via that method. It is hard on the nose so maybe just switch to sublingual for a while to give your nose a rest (although it doesn't "repair" afaik).

 

[candidsurprise]

It's hard to say exactly but I believe rectal you will get about 1/3 first pass liver metabolism, though this might not be the common wording. Basically, once absorbed about 2/3 of the blood will go to your brain where it can work and 1/3 gets diverted where it goes past your liver before making it to your brain where some will get filtered. It's been a while but I think this is right.

As opposed to intranasal where all of it should pass your brain first, just like sublingual.

Does it not work for you placing it under your tongue? You can also put it between your lip if you salivate a lot so it's stays in place longer. That or cover it with a little piece of paper towel under your tongue to keep any spit away for longer. If not opposed to sublingual I might have another thing you can try...

As @Crack'r asked, why not use it sublingually as is designed? AFAIK it is the best ROA and is highly effective. Snorting is too ime but that was more to get some kind of mild rush, but I can't see any reason to take it through rectal administration unless you have a problem with your mouth or gums or whatever. I would be worried about wasting it via that method. It is hard on the nose so maybe just switch to sublingual for a while to give your nose a rest (although it doesn't "repair" afaik).

I don't have enough to use sublingually, they limited my dose to 1.2mg per day total. I've tried to resolve this issue but trust me it's a dead end, where I live things don't happen rationally. I noticed that for me intranasal has 2x the bioavailability of sublingual, but since both of these options are closed I only have rectal left (I refuse to inject). So I really need to know details about rectal bioavailability and duration relative to sublingual and intranasal, if anyone has information about this.

 

[pharaoh]

I don't have enough to use sublingually, they limited my dose to 1.2mg per day total. I've tried to resolve this issue but trust me it's a dead end, where I live things don't happen rationally. I noticed that for me intranasal has 2x the bioavailability of sublingual, but since both of these options are closed I only have rectal left (I refuse to inject). So I really need to know details about rectal bioavailability and duration relative to sublingual and intranasal, if anyone has information about this.

As far as I understand it, that dose should work sublingually. That's how they traditionally taper you via the tablets. Can't you ask them to give you your dosage via a different method, like those strips they have? There has to be a way for it to work SL. I don't know about rectal administration so I'm sorry I can't help, I think you should speak to your prescriber and say that you aren't getting the dose. I get long term bupe injections (6 week half life, into a fatty area such as the lower abdomen) so there are other methods. Maybe even in a kid of dropper solution?

Perhaps someone will know how to help via the rectal ROA but I can't see it being any more effective than SL - I think you could potentially waste it much more easily. I've wasted a whole bag of H (0.2g bags, low level purity but high enough) by doing it wrong that way in the past so I don't know how that ROA would be better for such a low dose of bupe.

I know that you won't IV it but if you are dead certain against doing that, which is a good thing, then I can't see any other way other than finding a way to absorb it properly via the SL route that would be anywhere near as effective.

Even some kind of liquid solution on blotter paper could work better no? Obviously it is water soluble so perhaps it could be made into a water-based solution and dropped onto blotter paper, then held under the tongue? That would be my shot before trying the rectal route (after exhausting possibilities with the doctor/prescriber.

 

[Crack'r]

Most medicine is absorbed via a concentration gradient, so it moves from a high concentration to a low. So when using it sublingual your spit starts to dilute it and decrease the concentration. You can try making a pouch with a piece of coffee filter that will help to keep it from getting washed away. You can also put it between your lip and gum like tobacco dip which doesn't get nearly as much spit there. I salivate a ton so this is a problem for me, though even if it gets swallowed pretty quick I still can tell I got it, though it helps to have an empty stomach.

Buprenorphine will dissolve in water as well as alcohol. You can dissolve it in a small amount of liquor and put this under your tongue or in your lip a drop at a time. Liquor also gets absorbed by a concentration gradient which is why a shot will hit you faster than a beer. So stronger alcohol would probably help and since the buprenorphine is dissolved, it gets carried into your blood with the alcohol. I'd try this to start.

Rectal can work but you have to make sure you don't have to go to the bathroom and are completely empty. Otherwise it gets blocked from making good contact and also gets absorbed by "stuff" like a sponge which won't come back out. It can work but there's a good chance it also gets messed up unless you're prepared to get fairly intimate with yourself. And like I mentioned before, part of whatever that is absorbed gets diverted to your liver before going to your brain. I think first pass metabolism is the common terminology. Not all of it that goes thru your liver in one pass will be absorbed but a chunk of it will.

You can try different things but if it's not working good enough then maybe find a different doctor or tell them it's not enough to stop your cravings. But if you can stop it all together that should be the goal. Though you have to want to quit before most have much success with that.

Good luck!