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Thread: back and forth between opiates and suboxone

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    back and forth between opiates and suboxone 
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    so ive been on subs for a while, well to be kind of exact about like a month then i was addicted to subs so i started doing opiates again to start the process over again and just use the suboxone for like a five day maintenance thing just to help the pains of cold turkeying. so i did opiates for about two weeks straight and then went to start to my five days of subs. i took no more than 1mg of sub a day. i took these subs for 8 days instead of five because though embarrassing i couldn't get off the opiates for the first three days even though i took subs. my last day of subs i smoke a little bit of opiates and that was yesterday... so knowing my story can anyone tell me what im addicted to at this point if i feel like im withdrawling but dont know from what idk if i should just do a little bit of opiate today and cold turkey from subs tomorrow or... well actually there is no other option if thats not true cuz i cant keep taking subs at this point.. right? wont i get addicted to them if i use them for more than like a week?
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    #2
    Bluelighter jlcb24's Avatar
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    Suboxone is a combination of buprenorphine (an opioid receptor agonist) and naxalone (an opioid receptor antagonist). The reason this medication is thought to work is because buprenorphine does not have an affinity for the type of opioid receptor (can't remember the name) responsible for the euphoria that other opiates/opioids are known for. Additionally, naxalone's nature as an opioid receptor antagonist prevent the drug from being administered intravenously. I believe it is only absorbed by your body intravenously, having zero bioavailability when taken orally. A user who IV's this drug will immediately feel (possibly intense) opiate withdrawal symptoms.

    Your addicted to opiates/opioids in general, not any single one of the substances your taking. Administering any opioid agonist (hydrocodone, methadone, heroin, oxycodone, etc.) alleviates these symptoms temporarily. There is no point in taking suboxone if you're continuing to use opiates. One is supposed to recover from this addiction from slowly tapering off suboxone while abstaining from all other opioid agonists. If your goal is to overcome this, that's what I suggest you do. Otherwise, don't bother with the suboxone and continue the usage of the other substances without interruption.
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    #3
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    The post above me is filled with lots of falsehoods.

    Suboxone binds to and activates the mu-opiate receptor (the one that all the "classical" opioids bind to) but does not produce "full" activation of the receptor (not as much as endorphin produces). People who are dependent on drugs that activate the receptor fully (such as e.g. heroin or oxycodone) and then switch to a drug that has a high affinity for the receptors but low activity (like buprenorphine) will not have thir receptors activated enough which causes withdrawal. Buprenorphine itself binding and displacing opiates from your receptors is what causes precipitated withdrawal, not the naloxone.

    One of buprenorphine's metabolites that is produced when your body takes it in is norbuprenorphine - a much stronger agonist at the mu opioid receptor. This explains why sometimes "smaller" doses of suboxone will work better than huge bolus doses - your body converts a greater proportion of the less active buprenorphine into the more active norbuprenorphine.

    Naloxone, while it is indeed an opiate intagonist, is metabolized very rapidly and is actually out-competed at the opiate receptors by buprenorphine. It is a "feel good" addition to keep doctors thinking that IV use isn't worthwhile. In practice people inject Suboxone anyway and don't report unusually strong withdrawals.
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    #4
    how long does it take to taper down off subs?
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    #5
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    Depends on how long you've been using, your dosage, and many, many other factors.

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    #6
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    Quote Originally Posted by crazed chris View Post
    how long does it take to taper down off subs?
    It depends on a lot of factors.

    I would say if you are trying to quit opiates, try going 2 weeks on Suboxone, while slowly tapering. You may want to do a longer or shorter taper depending on how you feel.
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    #7
    Bluelighter jlcb24's Avatar
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    My apologies, I am new to studying analgesic drugs and mistakenly provided you with a number of false statements. However, even in the absence of an opioid agonist, naloxone (misspelled it above) has very poor oral bioavailability. Like sekio mentioned, it is subject to first-pass metabolism by the liver when administered in this manner and though most of the drug is absorbed, it produces little to no effect because of this.
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    #8
    Thank you for the corrections, sek - no offense jl, but my head was about to explode!

    You aren't really addicted to JUST suboxone or JUST whatever opioid(s) you're using - they both activate the same receptors so you're dependent on both or either. As sekio very concisely articulated, the suboxone doesn't produce as strong of the my agonist effects due to the ceiling effect of its partial agonism. If someone is hooked on xanax, they can easily take valium and not have any withdrawals because the drugs are cross-tolerant. You can say you're addicted to xanax, but really you'd be addicted to GABAa agonists. Likewise, you're dependent on opioid agonists rather than a specific drug.
    Last edited by Cane2theLeft; 31-08-2011 at 03:18. Reason: mu typo
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    #9
    Bluelighter Fire&Water's Avatar
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    Very well explained, Moderator's...Thanks
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    #10
    Bluelighter jlcb24's Avatar
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    I was only trying to help, though I should definitely get my facts straight before posting next time to avoid possibly detrimental consequences that come with giving false advice. I realize now I was wildly off base and that the mu opioid receptor is responsible for both analgesia and euphoria; thanks moderators for the knowledge. I don't know if this deserves its own thread, but what indications would a kappa opioid receptor agonist medication have?
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    #11
    ^ I thought this was relevant -

    It is now widely accepted that κ-opioid receptor (partial) agonists have dissociative and deliriant effects, as exemplified by salvinorin A. These effects are generally undesirable in medicinal drugs and could have had frightening or disturbing effects in the tested humans. It is thought that the hallucinogenic effects of drugs such as butorphanol, nalbuphine, and pentazocine serve to limit their opiate abuse potential. In the case of salvinorin A, a structurally novel neoclerodane diterpene κ-opioid receptor agonist, these hallucinogenic, more specifically deliriant and dissociative, effects are sought after, even though the experience is often considered dysphoric by the user. While salvinorin A is considered a hallucinogen, it is not a psychedelic, and its effects are qualitatively different than those produced by the classical psychedelic hallucinogens such as LSD or mescaline[cite]http://en.wikipedia.org/wiki/Kappa_Opioid[/cite]

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    #12
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    There is also the delta opioid receptor (activated by many analgesic opiates) that also provides some degree of pain relief and antidepressant effect.

    It is good to note that buprenorphine is a kappa antagonist.
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    #13
    Bluelighter OEandricearoni's Avatar
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    I feel you man i was in a similar situation when i was still using heroin. I would go a few days using H, then take suboxone for a few days, ect. But what i found was I was just addicted to opiates, not sub AND heroin. I could take suboxone and have little to no withdrawal from no heroin. I could take heroin and feel no withdrawal from not having taken suboxone. That's how it worked in my experience. For some reason, it didn't seem to matter what opiate i took it would eliminate my withdrawals. I used to buy vicodin if i couldnt get a hold of H and take a good amount, it wouldnt really get me high but it would take away my withdrawals. If you take one or the other you should feel better. But I'd say keep taking the suboxone, and try to taper off of it and be clean for good.
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