Opioids Help needed. Oxycodone vs suboxone

[zagor11]

5 years ago I got addicted to oxy. It helped my pre-existing depression. I was on very high doses, around 800 mg a day. Mid last year I went to suboxone mostly 18 mg and quit cold turkey to go to oxycodone again. But this time there was no high. Anyway, I know oxycodone right now at 300 mg a day worsens my depression so I decided either to taper off. I also considered suboxone. The reason to go to suboxone is that I hoped it would temporary ease my depression because I read recently that at lower doses sub is good for depression.

So I started with oxycodone taper. 20% Down to 240 mg from 300. First week ended yesterday and I was getting ready to taper another 20 %. During the first week I had ups and downs. I started feeling worse second half of the week. So just before I took my first second week dose I became very depressed. I went ahead and for first time in month I couldn't sleep.

Now I am slowly going back to my regular dose.

My other option is to take suboxone but I heard it is much harder to come off. Also I read that less is more so I don't know how much to take. How long? What are medications to help suboxone withdrawal?

If my depression doesn't get back to normal then I have no choice but go to bupe. If it does then would it be better to wean off but only less this time or switch anyway?

I hope somebody can help me out.

 

[Jabberwocky]

go with the suboxone in my opinion, you would avoid the risk of having a huge tolerance to oxys again too... and take care with the precip. w/ds search on the forums it is already covered a lot by different threads, but I will look on the subject a little more later.

 

[kleinerkiffer]

Going from 240 mg oxycodone to buprenorphine will be hard due to precipitated withdrawal. How did you switch to bupe when you took 800 mg oxycodone a day?

There's a whole thread on comfort meds for opioid withdrawal (this one might help https://www.bluelight.org/vb/threads/569872-The-Opioid-Withdrawal-Megathread-and-FAQ)
Some good meds would be:
Clonidine
Gabapentin/Pregabalin
Short term benzodiazepine
Loperamide (only small doses for the shits)

 

[NorwegianElkhound]

Wait until you're completely dopesick to start taking suboxone. The sub is a better lifestyle, but long term usage is a monster to come off of. If you eventually come off a long term suboxone maintenance habit, the withdrawals can last a week, even two in extreme cases. Be careful and know what youre getting yourself into

 

[apocalypse_when]

I imagine going on suboxone would be much cheaper than those huge doses of oxy which if you're not getting them from a doctor must be costing you a fucking fortune...

 

[zagor11]

It's not about money. I obviously cannot wean off of oxy even though I get zero high from it.

 

[zagor11]

@kleinerkiffer What would be the best dose of sub to start on considering I take 300 mg oxy and is it better to take with or without maloxone?

 

[kleinerkiffer]

@kleinerkiffer What would be the best dose of sub to start on considering I take 300 mg oxy and is it better to take with or without maloxone?

I don't have personal experience so I can only tell you from a equianalgesic standpoint
Oxycodone is around 1.5 - 2 times as potent as morphine with a bioavailability of around 70% so with 300 mg that's around 210 mg (or around 315 - 420 mg morphine with 100% morphine BA)
Buprenorphine is around 30-40 times as potent as morphine, but the bioavailability is only 30-50% (check out this thread to increase BA) so assuming 50% BA you're looking at a dose range of roughly around 8-14 mg of bupe assuming 100% cross-tolerance
I think it'd be better if you could tapper down some more before switching to bupe, but as I said, I have no personal experience, so I hope someone with experience will chime in and can help you.
If you switch make sure you're in some withdrawal to prevent precipitated withdrawal, COWS can help with that https://www.mdcalc.com/cows-score-opiate-withdrawal

As for pure bupe vs. bupe+naloxone: normally the naloxone shouldn't make a difference and only a few people react bad to it

The opioid system seems to play a role in depression, so try to do everything you can to boost natural endorphine production (i.e. exercise if you're fit enough or just a walk around your block to get some sunlight, maybe some spicy food if you lke it etc.)

I hope you're feeling better soon!

 

[speedballs_over]

Methadone?

I wanted to add, pardon me if it is repetitive - you may possibly have a difficult time covering a 300-mg/day oxy habit with bupe. Or not - people differ. Others can tell you better on this and the poster above did mention it though that post hits at my angle...

Is methadone an option? Even short term (1 - 3 months) to stabilize, level off and taper for a switch to bupe?

Methadone can be easier & provide more complete coverage of w/ds than bupe - for some. For some! Don't jump on me for that statement folks, I believe it's a generalization that has become less credible over time.

You can switch to bupe after tapering and discontinuing the methadone long enough to go into full w/ds. Bupe providers are generally easier to locate than good methadone providers - it's easier to access in general but just isn't the same.

To each their own.

Methadone may or may not help with depression, I've read here that it may well at a reasonable dose. I believe it's an NDMA agent (agonist? As with DXM?) possibly helping with depression - I need others to confirm this or to search the forum for info.

If you absolutely need a benzo - not that you mentioned anything - this may be an issue but there's no prohibition in the US to prescribing benzos with bupe or methadone - it's the policies of providers that fuck people up.

 

[kleinerkiffer]

^ methadone is a NMDA-Antagonist, same as DXM (or better the metabolite iirc) and ketamine
It seems that not ketamine but one of its metabolites (hydroxynorketamine) is responsible for the antidepressant effect, interestingly its not a NMDA-Antagonist and we don't yet know the mechanism of action of the antidepressant effect

 

[zagor11]

@kleinerkiffer Thanks for bringing this up (precipitated withdrawal) as I never heard of it before. When I was on arond 800 mg dose the first time, before I switched to sub I weaned somewhere just above 400. Now am at 300 again. Last year I waited 17 hours and just switched, Withing 1 hour I got 70% relief. But what is PRECIPITATED WITHDRAWAL? You asked me about it but I have no clue. Could you please explain to me in details about it?

@speedballs_over Thanks for your input. If sub cannot cover my oxy then that would explain why I never felt good on it last year. But if 1 mg od sub exuals 30 mgs of oxy then only 10 mg covers 300 right? Or am I wrong? When it comes to benzos I have been on klonopin 15 years and that's another drug I need to wean off. That's why I have fear about methadone. Overdoses on methadone are huge comparing to suboxone.

Also something weird happens to me. Or it may be normal because I get no high from oxy.Sometimes I can go all day on oxy without withdrawal, except mild ones. And it's more often that not. Two time I got stuck somewhere without my oxy and I had no withdrawal for 15 hours except fatigue. That also makes me worry how to quit and switch if I am not in withdrawal.

 

[Hodor]

Buprenorphine is a so-called "partial agonist". It works by binding to opioid receptors very strongly, but when bound it cannot activate them as easily as other opioids.

When you are on a low dose, the high binding affinity can make up for its lack of efficacy at activating each individual receptor. Once you increase the dose, however, the buprenorphine molecules have to compete with each other for the receptors, so dose-response curve quickly approaches a "ceiling" where an increased dosage will no longer yield an significant high in terms of opioids effects.... in other words, no, 10 mg of bupe isn't going to be anywhere near 10 times as strong as 1 mg.

 

[Hodor]

To expand on my point: As I said, the effects of buprenorphine tend to approach a "ceiling". That "ceiling" may be lower than the amount of opioid receptor activation that an opioid-dependent person needs to prevent withdrawal effects.

When an opiod-dependent person ingests buprenorphine, the bupe will displace the other opioids currently in your system from their receptors, but cannot fully activate them. Basically, you will be pulled down to buprenorphine's "ceiling", which as an opioid-tolerant person would suddenly put you in "withdrawal" territory (hence: precipitated withdrawal).
This is why it is generally suggested to only start buprenorphine when you're already in withdrawal.

This site gives an excellent, more in-depth explanation:
https://psychopharmacologyinstitute...orphine-opioid-use-disorder-mechanism-action/