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Higher dose buprenorphine counterproductive?

T

therealog

Greenlighter
Joined
Aug 29, 2012
Messages
35
Probably merge to bupe megathread I assume. Final answer- is taking higher dose bupe counterproductive or not? Ya know the whole bupe/norbupe argument. My bad I have a very swollen index finger. I'm in the hospital and labeled as an IDU (intravenous drug user) no doctor will give me pain medication. I have access to Suboxone 8mg twice a day and toradol ?mg every 6 hours. I also have my own Subutex from home and soma so fuck them. Should I up my own dose or is it like enzyme dependent per person type shit where I'll never know if it's better for me or not? Oh and look up flexor tenosynovitis. It's not fun and I'm going to be in here for my birthday probably and miss Sunfest because I can't leave with an IV because I'm an IDU fuck society man. Endrant. Don't shoot speedballs or anything for that matter.
 
Generally speaking it seems to act more as an agonist at a lower dose. But will more help increase analgesia? I’m not sure myself. I’ve taken higher doses (12mg for instance) and it definitely seems like it’s more effective than a lower dose (2mg). How much gain that will be, I don’t know.

If you aren’t tolerant to opioids, or you aren’t tolerant to buprenorphine, please don’t take too much until you know how it will affect you.
 
Yeah I'm on maintenance 24mg buprenorphine so I'm thinking more is more in this case as opposed to the usual "less is more"
 
therealog said:
Yeah I'm on maintenance 24mg buprenorphine so I'm thinking more is more in this case as opposed to the usual "less is more"
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Unfortanetly in your situation more is not going to result in more pain relief. As habitually stated by other posters on BL buprenorphine has a ceiling effect . This is usually around 12-16 mg and used to be 24 mg. The ceiling effect has been hypothisesed to be lower then 24 mg. At a certain point the drug can result in antagonistic effects if the dose is taken to high.

In my opinion 24 mg is to high of a dose. I found anything over 12 mg is going to result in extremely limited amount of increased opioid like effects while a dose lower then that provides the same pain relief with less side effects. Less is more. That's why there are hundreds of threads on BL with that specific title.
 
Okay so I forgot to mention I don't take the whole 24mg at home I usually max out at 12mg at home and I am sometimes forced to put the 2 films they give me a day here at the hospital under my tongue I know I only get like 30%. So with all due respect Prescottdave to your UTFSE comment can you tell me if 12-16mg sublingually, nasally, or IV is when the ceiling effect with bupe occurrs with reliable sources?
 
While this wasn’t my experience (2-4mg would generally keep me well just fine), I have known people who would not feel okay with less than 16-24mg buprenorphine. It’s rare, and the people I’m thinking of had large fent habits prior to transitioning, but it’s not unheard of. More than most need, but from my limited experience it what some people seem to need.

I think the ceiling effect is generally thought to be between 16-24mg depending on the user. It used to me like 32mg, over 24mg I mean. I don’t really know. All the ceiling effect stuff is for sublingual use. I’d imagine it would be lower with IV, about the same (a little less) with intranasal dose.

Google has lots of research papers on this though ;)
 
therealog said:
Okay so I forgot to mention I don't take the whole 24mg at home I usually max out at 12mg at home and I am sometimes forced to put the 2 films they give me a day here at the hospital under my tongue I know I only get like 30%. So with all due respect Prescottdave to your UTFSE comment can you tell me if 12-16mg sublingually, nasally, or IV is when the ceiling effect with bupe occurs with reliable sources?
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Search it yourself. I easily found loads of information discussing the SL ceiling dose. It used to be considered 32 and was lowered to 24mg. This is why in many states insurance companies will not cover more than 24 mg per day based on research done by the NIH.They also used to cover 32 mg per day. Here is a basic source that concludes the drug has a ceiling. Research into the ceiling effect or a bell shaped curve effect in terms of analgesia is so prevalent in preclinical trials one study discusses the fact that it has hindered a good deal of research into the drug for pain. The last study discusses the fact that the ceiling dose still remains around 24-32 mg.
https://www.ncbi.nlm.nih.gov/pubmed/8181201
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999180/
 
therealog said:
Probably merge to bupe megathread I assume. Final answer- is taking higher dose bupe counterproductive or not? Ya know the whole bupe/norbupe argument. My bad I have a very swollen index finger. I'm in the hospital and labeled as an IDU (intravenous drug user) no doctor will give me pain medication. I have access to Suboxone 8mg twice a day and toradol ?mg every 6 hours. I also have my own Subutex from home and soma so fuck them. Should I up my own dose or is it like enzyme dependent per person type shit where I'll never know if it's better for me or not? Oh and look up flexor tenosynovitis. It's not fun and I'm going to be in here for my birthday probably and miss Sunfest because I can't leave with an IV because I'm an IDU fuck society man. Endrant. Don't shoot speedballs or anything for that matter.
Click to expand...

It appears that by taking lower doses of Buprenorphine, you can basically maintain the affinity for the Mu receptor, which is, in simple terms, "the good one". As the dose increases the pharmacokinetics and the subjective experience of the drug change. I really don't know enough to make a confident statement on the subject, but if you want my opinion, lower doses are essentially "worth it".
 
Basically once buprenorphine saturates enough receptor, the net effect is antagonistic. This may be due to endorphin displacement as well as nociceptin receptor activity.
 
therealog said:
can you tell me if 12-16mg sublingually, nasally, or IV is when the ceiling effect with bupe occurrs with reliable sources?
Click to expand...

This is an interesting question

I'm sure the simple math of SL 10% BA, IV 100% BA, 1/10, 10% of the SL ceiling dose, wouldn't work out. The equation is pry a lot more complex.
 
i agree 24 is a uselessly high maintenance dose to be on. you could get by just as easily halfing the dose over a week taper
 
I actually believe that this change occurs around small dosages of like 1mg-2mg or even less. You will find that as an analgesic, Buprenorphine (Buprenex, Temgesic) is dosed in significantly lower levels than Buprenorphine (Suboxone, Subutex).

These guys make a lot of money and if my assumptions are correct, based upon the well-known and cavalier greed of Pharma, they're probably getting paid by the weight of Buprenorphine they sell. Maybe it's not that bad and all formulations and dosages are paid out by the pill/strip, what have you, but they are making money off of your addiction and Doctors are cozy with Pharma in a disgustingly sinister way in some cases.

Doctors, who could conduct simple research into the pharmacokinetics of Buprenorphine, still (much like Benzodiazepine prescriptions) openly flout what are nearly absolute terms regarding the prescription of this substance. All Doctors in the United States are guilty until proven innocent. This bullshit of overprescribing everything could not happen in any way, shape or form without Doctors agreeing to Pharma's agendas.
 
Keif' Richards said:
I actually believe that this change occurs around small dosages of like 1mg-2mg or even less. You will find that as an analgesic, Buprenorphine (Buprenex, Temgesic) is dosed in significantly lower levels than Buprenorphine (Suboxone, Subutex).

These guys make a lot of money and if my assumptions are correct, based upon the well-known and cavalier greed of Pharma, they're probably getting paid by the weight of Buprenorphine they sell. Maybe it's not that bad and all formulations and dosages are paid out by the pill/strip, what have you, but they are making money off of your addiction and Doctors are cozy with Pharma in a disgustingly sinister way in some cases.

Doctors, who could conduct simple research into the pharmacokinetics of Buprenorphine, still (much like Benzodiazepine prescriptions) openly flout what are nearly absolute terms regarding the prescription of this substance. All Doctors in the United States are guilty until proven innocent. This bullshit of overprescribing everything could not happen in any way, shape or form without Doctors agreeing to Pharma's agendas.
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Oh, I know... my doctor was always trying to get me to up my dose. He said he had patients on ~30mg of suboxone. Its a good thing I knew a thing or two about suboxone before meeting with him or my addiction might have been significantly worse than it is now.

For doses I found 6mg to feel better than 4mg and 4mg to feel better than 2mg. But 8mg didn't seem to increase positive effects and just made me more nauseous.
 
I've heard of pain patients being on 40+mg but I can't remember the reason. Maybe something to do with receptors in the body rather than the brain. Couldn't find it with search .. though I did have a quick look. May well just have been poor prescribing practice.

On the whole I think you're probably best off adding in a couple of paracetamol and/or an ibuprofen if you can tolerate them. Soma (Carisoprodal) would be good provided it's not a regular thing. You don't want a barbituate habit.

I've taken 60mg bupe before when withdrawing but only because of the poor compatibility between sublingual administration and lying screaming in a pool of your own vomit (neat fent is AWESOME till you run out!).
 
therealog said:
Yeah I'm on maintenance 24mg buprenorphine so I'm thinking more is more in this case as opposed to the usual "less is more"
Click to expand...

Seems like that's a pretty high dose for a maintenance dose. The highest I ever went to with a doctor was 16 mg for about six months, then started tapering down. I didn't feel any withdrawals until I got to about 4 mg, and then I had to slow my taper down to about 10% of my dose every couple of months. The lowest I could get any pain relief from was what I'm on now, 1/8 mg daily. I've been on that for several months, and any lower I get sick as well as no pain relief, but a small amount higher doesn't seem to do much. Even quite a bit higher doesn't seem to make much different. It may just be that I'm really habituated to the drug. This is only my experience using it SL--I have no desire to try it IV or snorting. Used to IV pills and had some bad side effects, so I don't do that any more...
 
It isn’t very significant, but just pointing out that carisoprodal isn’t a barb. Similar enough to make the statement still accurate though.
 
i think the ceiling effect of bupe is impossible to quantify and has got to be determined by a bunch of factors of the individual taking it... i mean the only way i could tell the difference between 6mg and 32mg would be the amount of time the inevitable junk sickness takes to rear its head. though i've taken doses as small as <1mg and it failed to even cure the sickness, so its a difficult drug to wrap my head around.
 
Ill tell you first hand, before I got railroaded by a couple CI's I use to do between an 8th and a 16th of bupe a day. Since than I had to join a program so I would have reason for it showing up they have increased me to 12 mg a day. I usually take 8. And the difference between 1 mg and 8 mg after tolerance leveling off is ALMOST non existent. Stick with the lowest dose you can, don't mess up like I did.
 
I'm still trying to figure out my dose rn. Last time I was taking like less than half a mg and was fine but this time I had a bigger habits and it's taking some time to get used to the sub. I still feel risidual wd symptoms. So I'm definitely not taking enough. I take around 8mg daily. I wanna get it back down to what I was doing before tho. It was great. Rn it's still shitty but it's early. Give me time and I think it'll get back to the way it was. I hope
 
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