Harm Reduction Quiting fentanyl...can subs do the thing?...

Well, i'm on fentanyl patches for 8 years. My dose is a 100mcg/hr every 2 days(48 h). I'm prescribed them for chronic pain, which is very bad. I just wanna know what do you BL'ers think, can i quit with suboxones, or the only way is the methadone. If somebody have done it,i would be very interesting to listen some good advices. I also use h (snort) once a week..If anyone can help me..ya know...Thanks.


MartinFn

The thing about bupe is you need to wait until alllllllll the full-agonist opioids like fentanyl are out of your system before you can dose.

And with fentanyl, being a super strong, super short acting full agonist, will have some dreadful withdrawal symptoms, and your pain will be through the roof. Which leads to my next point, if you're a chronic pain patient, you're not going to want to be on subs because then you can't take any other full agonist opioids to control your pain.

Methadone would seem to be the better option, as it does not have a ceiling dose. Why are you switching off fent?

Tricomb has some good points.

Fentanyl is super short acting, so on the one hand, after 24 hours, it is highly unlikely that you will experience precipitated withdrawal. On the other hand, your withdrawals will most likely start much earlier, and be more intense. If you insist on using suboxone/subutex, I would recomend switching to a different opiate like oxycodone for a few days before jumping onto the suboxone.

Also one thing to remember is that fentanyl is incredibly potent, and transdermal BA is really high. Buprenorphine is also very potent, but it has a cieling effect, which means that if you're tolerance is higher than bupe's peak agonist activity, that even if you dont experience precipitated withdrawals, you will still probably feel uncomfortable on subutex. It would be comparable to switching to a lower dose of fentanyl which didn't quite get you straight.

However, that being said, you probably wont have to worry about that. Just know that taking more than 8 mg in a 24 hour period is pretty much useless. I've found for me that at that dosage, it levels off in terms of relieving withdrawals, or producing more opioid effects.

Like Tricomb said, I think methadone would be a more bullet proof approach.

Good luck, and let us know how things turn out.

The other problem would be your pain...

It's better to at least give suboxone a chance before going down the methadone route. There's really no harm in trying bupe to see if it works, just as long as you wait long enough before dosing so that you don't experience precipitated withdrawals.

If he starts suboxone, what will he do to control the pain that he needed FENTANYL to control?

im sorry to say you have a hard, long road ahead of you. i was on opiates for about 5 years. started with percs, then oxy and fent, then to iv heroin. finally quit with help from subs, but mostly it was the moving 2700 miles west that led to me living the clean life. subs took a very very long time for the withdraw to stop, but wasnt as severe as quitting cold turkey from the shorter lasting opiates. the second time i quit opiates was much eaasier, due to hearing about an herb called kratom. it worked alot better then the subs, withdraw wasnt nearly as bad, didnt last nearly as long, and didnt need a doc to get it. look into kratom. its not an opiate, but def gets rid of 90% of withdraw symptoms. i went from shooting 8-12 bags a day of some of the best powder dope in camden to kratom 3 times a day and the worst my withdraw got was a runny nose and only able to sleep about 3 hours a night. no restless legs with cramps, no anxiety or cravings, no diarhea, no vomitting, nothing but the runny nose. its like god made this herb just to get people off opiates. you should def look into other options before methadone. that stuff gets into your bones and is harder to get off then cold turkey from shooting heroin. just like suboxone, methadone is good if your looking to just stop harder opiates and substitute it with another chemical, but if you really want to quit and not be dependant on anything, its either cold turkey or using kratom and quickly tapering down after a week. at least this was my experience, and whatever you choose, i wish you all the luck in the world. its a bitch to get off opiates, but once your done yooull feel great about yourself getting off something thats so hard for so many to quit. good luck

Can you tell us a little more about your chronic pain concerns? Because Suboxone is not indicated for the control of chronic pain. I was taking it to kick a morphine habit when I developed a tooth root abscess and I thought I was going to pull that tooth out of my head by myself with a pair of pliers--nothing that the dentist could prescribe was able to break through the Suboxone, it is that strong of a blockade.

But if you're using it to get clean, it will work, but not on it's own. I find that people have unrealistic expectations about Suboxone; you still have to do the work.

tricomb said:

If he starts suboxone, what will he do to control the pain that he needed FENTANYL to control?

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Missykins said:

Can you tell us a little more about your chronic pain concerns? Because Suboxone is not indicated for the control of chronic pain. I was taking it to kick a morphine habit when I developed a tooth root abscess and I thought I was going to pull that tooth out of my head by myself with a pair of pliers--nothing that the dentist could prescribe was able to break through the Suboxone, it is that strong of a blockade.

But if you're using it to get clean, it will work, but not on it's own. I find that people have unrealistic expectations about Suboxone; you still have to do the work.

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Buprenorphine actually is used to treat pain, but usually in the form of Butrans (buprenorphine transdermal patches) and Temgesic. Suboxone and moreso Subutex have also been used for the treatment of pain. I know people in pain clinics that are prescribed it for this reason.

"Butrans is a transdermal formulation of buprenorphine indicated for the management of moderate to severe chronic pain in patients requiring a continuous, around-the-clock opioid analgesic for an extended period of time" (source).

also,

"Depending on the application form, buprenorphine is indicated for the treatment of moderate to severe chronic pain (pain that has outlasted its use to prevent injury and after three months) or for peri-operative analgesia. For the treatment of chronic pain, the transdermal formulations (Which was recently released in January 2011, It is available in 5mcg [micrograms per hour], 10mcg, 20mcg,Trans dermal patches[17]) are preferred, which can be used both for chronic cancer pain as well as chronic non-malignant pain, such as musculoskeletal and neuropathic pain such as is found in diabetics with neuropathy. The intravenous formulation is mainly used in postoperative pain (for example, as patient controlled analgesia [PCA]) and the sublingual formulation is, for example, used as breakthrough medication for patients with basic transdermal treatment" (source).

What you should do is find a knowledgeable and unbiased doctor and sit down and talk with them about whether bupe or methadone is right for you. It seems like you would be a more ideal methadone patient than bupe, but methadone treatment can be somewhat debilitating in its own right, or so I've been told...

As TB stated, both can be used to treat pain. I know personally of more people who take bupe to manage their pain, who were already opioid dependent/addicted than people who take methadone. I think it really comes down to you and your kind(s) of pain. Methadone, at higher doses, would probably work better to control the severest of sever pain, while bupe's ceiling would stop it from doing so with the same efficacy. However, for most chronic pain patients, I think that bupe would at least hold its own, if not (in combo with other pain medicines such as lyrica, etc. etc.) be more than enough support.

Tommyboy said:

Buprenorphine actually is used to treat pain, but usually in the form of Butrans (buprenorphine transdermal patches) and Temgesic. Suboxone and moreso Subutex have also been used for the treatment of pain. I know people in pain clinics that are prescribed it for this reason.

"Butrans is a transdermal formulation of buprenorphine indicated for the management of moderate to severe chronic pain in patients requiring a continuous, around-the-clock opioid analgesic for an extended period of time" (source).

also,

"Depending on the application form, buprenorphine is indicated for the treatment of moderate to severe chronic pain (pain that has outlasted its use to prevent injury and after three months) or for peri-operative analgesia. For the treatment of chronic pain, the transdermal formulations (Which was recently released in January 2011, It is available in 5mcg [micrograms per hour], 10mcg, 20mcg,Trans dermal patches[17]) are preferred, which can be used both for chronic cancer pain as well as chronic non-malignant pain, such as musculoskeletal and neuropathic pain such as is found in diabetics with neuropathy. The intravenous formulation is mainly used in postoperative pain (for example, as patient controlled analgesia [PCA]) and the sublingual formulation is, for example, used as breakthrough medication for patients with basic transdermal treatment" (source).

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Yes, buprenophrine is, but Suboxone is not. Read the prescribing info.

^ It's called prescribing it for off-label uses. Plenty of Doctors here prescribe Suboxone for pain management. They both have the same active ingridient, so it's not like it's such a far out idea for them to prescribe Suboxone for pain when other preparations of bupe (some of which are also sublingual) are being used to treat pain.

What baffled me was that buprenorphine has such a high transdermal BA, higher than sublingual I'm pretty sure. The only problem I see is that the OP is on a pretty high dosage of fentanyl, so I don't know if his tolerance would make buprenorphine useless, potent as it is. I've never been treated for chronic pain, but I would imagine that switching to BuTrans would really be most effective if you're switching from a much weaker full agonsist like oxycodone.

The other problem is the cieling effect. While buprenorphine is more potent microgram for microgram than fentanyl is, it levels off at around two mg or so (this depends on BA, I would say that with 100%BA, it would be closer to 1mg). The op is taking 100mcg patches, which means that he's getting somewhere around 1-2mg of fentanyl in his system over a 24 hour period (not sure of fentanyls transdermal BA, though I'm pretty sure it's high as well). So if the ammount of fentanyl absorbed at that dosage is more potent than buprenorphine's cieling I would imagine he might run into problems in terms of pain and withdrawal..however this is all just theory, I've never known someone transitioning from such a high dosage of fentanyl to buprenorphine.

^ I think the pain issue would be bigger than the withdrawal issue. I think bupe would give them an accurate idea of the extent of their pain. Since they have been taking fentanyl for 8 years, a lot may have changed over time in terms of the extent of the pain, and it's difficult to tell when taking opiates daily because lowering the dose or waiting longer between doses will cause withdrawal symptoms that feel like pain.

Bupe can at least allow them to assess the pain situation with minimum withdrawals being present, therefore allowing them to get a better idea of the pain level without withdrawal complicating things.

There are a lot of people that get better (in terms of pain level) over time but don't realize it because they stay on their meds and when they take less they can't tell the difference between actual pain and withdrawal type pain. Then there are other people that will still have that same pain level after a long time, so some of the options for ways to find out what's what is to either taper down slowly, or try bupe.

First of all, i wanna thank all you Bl'ers mates for your posts. I found a lot of useful info in them. The thing is that i'm in fent for 8 years, but before that i was using h for 10 years(benzo and weed too). I tried to quit many times, and the only thing that i managed to, was staying clean for some time(not long), and then relapsed. The first time that i use fent, i remember that i stuck the patch on me, and after some hours i was surprised, it took all the W/D symptoms and my pain too. When i started using h, it was for recreational reasons, the pain (neuropathetic) thing, and so the fent, came after. So fent did the job, as except for taking my pain off, it gave me a palliative care which i needed and i also need now. What i wanna say is that except for the pain, i use fent for recreational and palliative care reasons, too, and i'm sorry, i didn't mentioned it in my first post. I'm also prescribed lyrica and Elavil (amitryptilline), and sometimes i use benzo's, for recreational use, as i find that they give me a litl bit of euphoria, which i need desperately. Anyway, the reason that i want to get off the fent, is the W/D symptoms that i have, when the time to stick a new one comes by. But i think that bupe is not an option, i was almost sure about it, and your posts confirmed it..for two ways,the first one is that i'm not sure that it would take the W/D symptoms (fuckin tolerance), and the other is that it wouldn't take the pain off, and as it's antagonist properties, i wouldn't have the option to use an opiod painkiller, as Tricomb mentioned. I don't think that i can quit opiates right now, so my deal is to replace fent with smth else which can kill the pain and give me some litl kind of euphoria, a nice warm feeling, i'm sure you all know what i'm talking about. I think that Opana could work fine for what i'm searching about, but fuckin unfortunately, it's not an option. Staying on fent 100 for 48h and using dilaudid, oxycontin or even MS Contin, could be a good combo, but it's not an option too..I'm not positive for methadone, cause i know that is VERY difficult to wear off, but i have a thought in my mind..Could a combo of fent and (low dose, i think) of methadone work for me?..i mean that could this combo, except of taking the pain off, give some mild euphoria, some nice warm feeling? I'm very interesting to know your thoughts about it, and of course if smth else (kratom, nigella sativa, etc.) could work for me...A lot of thanks to all you mates, i know that you can feel me...%)


MartinFn

To whoever asked: Transdermal Bio Availability for Fentanyl is 100%

Best of luck to you Martin

tricomb said:

Best of luck to you Martin

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Thank you very much, Tricomb. You're a very good person. My problem is difficult, but i hope i'll find a fuckin answer..%)


MartinFn

Thanks, there's an answer out there for you, I just don't think it's subutex (I don't think it's strong enough, and it doesn't allow for supplementation with other opioids).

MartinFn said:

Anyway, the reason that i want to get off the fent, is the W/D symptoms that i have, when the time to stick a new one comes by.

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Dumb question, but: Are you getting the polymer matrix patches or the gel patches? If you have the polymer ones, couldn't you cut them in half and wear each half for two days, switching out the 2-day old half for a new half each day? (Keeping the one-day old half in place, of course.) Or, if your doc / insurance / financial situation allows, get twice as many half-strength patches?