Bupe Bupe withdrawals, how much longer?

[Africanus]

I stopped injecting my bupe 10mg a day about 2weeks ago when I was transferred onto the film.
Now I just sublingual my 10mg.

I've been getting progressively sicker the last few days, it feels to me like withdrawals.

I think the mechanism is the reduced real dose due to lower bioavailability of sublingual vs IV.

Anyone have any experience in withdrawals brought on by changing your ROA of your bupe or other DOC?

How long before my body settles down and accepts the new dose?

I don't want to return to injecting but I also don't want to feel like this every fucking day.

I've never had full blown withdrawals in all the years of my opiate usage, always been able to score within 24 hours max.
I'm worried this will get worse and then I'll become desperate, especially if I take all my doses sublingual and have no bupe to inject, and I'll go mad or return to morph.

 

[Trigeminal]

I honestly don't think it's withdrawal, dude. 10 mg per day is a ceiling dose (actually way past it). So your receptors are saturated--you could take 40 mg a day, and it would be the same as if you were taking 10 mg. That's why suboxone works--you take enough to keep your serum levels of the drug constantly above the ceiling threshold.

 

[Africanus]

I honestly don't think it's withdrawal, dude. 10 mg per day is a ceiling dose (actually way past it). So your receptors are saturated--you could take 40 mg a day, and it would be the same as if you were taking 10 mg. That's why suboxone works--you take enough to keep your serum levels of the drug constantly above the ceiling threshold.

Actually 34 mg real dose, is ceiling dose.

You'd have to inject that 34 mg though as if you sublingual it you will only get 1 third of the dose.

So sublingual 10 mg is only around 3 mg real dose.

I don't know where you got the idea that 10mg real dose is ceiling, that's totally false.

So essentially I've gone from 10mg real dose ( via IV) to 3 mg real dose (via sublingual).

I have withdrawals.

Which disappear instantly each morning when I dose, and come back that night.

 

[Africanus]

Oh and I'm well aware that bupe levels build up in my blood due to redosing period being shorter than bupes half life.
But while 10 mg IV may build up to ceiling dose, the 3mg a day I get from sublingual the 10 mg will not build up to those levels.

 

[Tommyboy]

The sublingual BA is 35-40%, so your dose is more like 3.5-4mgs compared to the 10mgs. Have you considered administering it sublingually in a ethanolic solution, which can increase the BA by up to 10%, making it 50%?

2 weeks is a pretty long time for you to be experiencing this, especially considering that you are still taking it. I was taking 16mgs sublingually for 18months, and tapered to nothing in a matter of 3 weeks, and most of the withdrawal symptoms (other than depression) were over after about 8 days.

 

[Africanus]

The sublingual BA is 35-40%, so your dose is more like 3.5-4mgs compared to the 10mgs. Have you considered administering it sublingually in a ethanolic solution, which can increase the BA by up to 10%, making it 50%?

2 weeks is a pretty long time for you to be experiencing this, especially considering that you are still taking it. I was taking 16mgs sublingually for 18months, and tapered to nothing in a matter of 3 weeks, and most of the withdrawal symptoms (other than depression) were over after about 8 days.

I assume you mean alcohol mixed with the bupe?
Ill look that up and I'll try that with my weekend take homes, thanks for the practical advice tommy.

 

[Trigeminal]

WAfricanus--It has a 37 hour half life. 1 day is 24 hours. It builds up in your blood as you take it daily. THATS THE ENTIRE POINT OF SUBOXONE, that your receptors stay saturated.

Edit: Yes, you'll reach saturation taking 10 mg a day, even accounting for the fact that it's only about 3 to 4 mg. Anything above 2 mg will build up to a ceiling dose.

 

[Pjkt2501]

WAfricanus--It has a 37 hour half life. 1 day is 24 hours. It builds up in your blood as you take it daily. THATS THE ENTIRE POINT OF SUBOXONE, that your receptors stay saturated.

Edit: Yes, you'll reach saturation taking 10 mg a day, even accounting for the fact that it's only about 3 to 4 mg. Anything above 2 mg will build up to a ceiling dose.

I'm a) pretty sure he realizes there are 24 hours in a day, and b) ROA has changed, as such has the "effective" dose; to less than 1/3 of what he was taking. Now that it's 336 (24*14 - length since primary ROA stopped) later, the levels in his receptor system are much lower than before.

OP: Do you use benzos, and if so, how has your dosing been with those?

 

[Trigeminal]

I'm a) pretty sure he realizes there are 24 hours in a day, and b) ROA has changed, as such has the "effective" dose; to less than 1/3 of what he was taking. Now that it's 336 (24*14 - length since primary ROA stopped) later, the levels in his receptor system are much lower than before.

OP: Do you use benzos, and if so, how has your dosing been with those?

Less than one third is not right. Sublingual is 35 to 40%. Only real explanation I can think of is that he is metabolizing it faster
than the average 37 h half life.

Especially since it's been 2 weeks. Assume he had 0 suboxone in his system,
It should have only taken him about 8 days to build up to the ceiling dose.

 

[Pjkt2501]

Less than one third is not right. Sublingual is 35 to 40%. Only real explanation I can think of is that he is metabolizing it faster
than the average 37 h half life.

I certainly metabolize it faster (but also take MUCH lower doses when I do [1-2mg/day]). However even 2mg is gone in 18 hours or so. 12 and I get that rater tell-tale "click" where the impending warmth just switches off and doesn't come on properly (and then get a bit miffed I didn't just wait and wasted $$).

 

[Tommyboy]

Edit: Yes, you'll reach saturation taking 10 mg a day, even accounting for the fact that it's only about 3 to 4 mg. Anything above 2 mg will build up to a ceiling dose.

I'm pretty sure that the ceiling dose is a lot higher than that, around the 32mg dose. If the ceiling dose is what you say it is, then there wouldn't be much of a point in having 8mg pills. I know that most of us agree that doctors prescribe higher doses than needed, but I wouldn't say that anything above the dosages you stated would all feel the same. That's like saying that anyone taking 32mgs daily can drop down to a low dose right away, and then taper down from there. I think that most people on say, 16mgs, can drop down to 10mgs right away with little to no discomfort, but after that they would need to taper by 1 or 2mgs a week to avoid bad withdrawals after reducing each dose.

Edit: I have been told that the ceiling dose for agonist effects is 2-4mg, although higher doses will still have an effect on withdrawal and blockade.

 

[Trigeminal]

I'm pretty sure that the ceiling dose is a lot higher than that, around the 32mg dose. If the ceiling dose is what you say it is, then there wouldn't be much of a point in having 8mg pills. I know that most of us agree that doctors prescribe higher doses than needed, but I wouldn't say that anything above the dosages you stated would all feel the same. That's like saying that anyone taking 32mgs daily can drop down to a low dose right away, and then taper down from there. I think that most people on say, 16mgs, can drop down to 10mgs right away with little to no discomfort, but after that they would need to taper by 1 or 2mgs a week to avoid bad withdrawals after reducing each dose.

Edit: I have been told that the ceiling dose for agonist effects is 2-4mg, although higher doses will still have an effect on withdrawal and blockade.

Well, my understanding is that it builds up to 32 mg over time--so as long as you are taking at least 2 mg day, after a certain period of time it will build up 32 mg.

Based on this psychiatrist's video: http://www.youtube.com/watch?v=lrqjJGoSQgc

He mentioned in another video that 2 mg daily would lead to opiate receptor saturation (after a few days).

I understand what you're saying though. It seems like someone on 32 mg should be able to drop their dose right away. I can't explain that. But just based on the >24 h half-life of the drug and enzyme saturation, this theory makes the most sense to me.

 

[Africanus]

Well, my understanding is that it builds up to 32 mg over time--so as long as you are taking at least 2 mg day, after a certain period of time it will build up 32 mg.

Based on this psychiatrist's video: http://www.youtube.com/watch?v=lrqjJGoSQgc

He mentioned in another video that 2 mg daily would lead to opiate receptor saturation (after a few days).

I understand what you're saying though. It seems like someone on 32 mg should be able to drop their dose right away. I can't explain that. But just based on the >24 h half-life of the drug and enzyme saturation, this theory makes the most sense to me.

No no you need to understand the mathematics involved.

Although blood levels do build up each day, they build up by a smaller amount each day, though never reaching zero.
So the build up decelerates while remaining a real amount.

Try adding 2 plus one half of two then one half of one then one half of 0.5 and so on, you will never ever reach 4 in total no matter how many times you increase the number as per this decelerating pattern. (this pattern is not the one used by bupe, it's just an example.)

I know the concept of an infinate series never reaching above a finite number seems contrary to commonsense, but thats how it works and so two milligrams would ever add up to 32.
Two milligrams will never even reach 8 mg because of the deceleration profile.

 

[Africanus]

Oh and to the person who asked, I'm not on benzodiazepine. I tried it and hated it.

 

[Africanus]

Here are some approx calculations:

1mg per 24 hours.

After first 37 hour period there will be 1.5mg blood level.
Total increase of .5mg.

After second 37 hour period there will be .75 leftover plus an additional 1 milligram, equals 1.75mg.
Total increase is .25mg.

These calculations are not exact but can you see the decline, the decelerating rate of the increase in blood levels of bupe?

 

[syKonaut]

I've been taking my friend to his sub clinic for a while now and he went from IV 2-4 50 bags of H a day to 12mg of Suboxone for around a month and a half then down 2mg every week. He was down to 6mg 2 weeks ago and now every 2 weeks will go down 2mg more. Yesterday he went down to 4mg. He's doing pretty good.

 

[DexterMeth]

Just out of curiosity, is the sublingual bio-availability at that percentage for bupe period, or just the pills? I ask because I found the newer "film strips" to have a better efficacy than the pills. -clean now, just curious.

 

[Tommyboy]

Here are some approx calculations:

1mg per 24 hours.

After first 37 hour period there will be 1.5mg blood level.
Total increase of .5mg.

After second 37 hour period there will be .75 leftover plus an additional 1 milligram, equals 1.75mg.
Total increase is .25mg.

These calculations are not exact but can you see the decline, the decelerating rate of the increase in blood levels of bupe?

I understand that, and how it causes a ceiling effect. I'm just confused about how sources say that the 2-4mg ceiling effect is for respiratory depression, whereas there seems to be a separate higher ceiling effect for the blockade effect and withdrawal.

I'm surprised at how difficult it still is to get accurate information on Suboxone. Once I read that the article, journal, or website says that IV use of Suboxone will cause precipitated withdrawal due to the naloxone in it, the rest of the information loses its merit to me. It's hard to comprehend why naloxone was put in Suboxone when there was already published data saying that buprenorphine has a higher binding affinity than naloxone. It may be even harder to comprehend how Doctors still think that patients cannot IV Suboxone, so they will only prescribe Suboxone and never Subutex.

 

[Africanus]

Just out of curiosity, is the sublingual bio-availability at that percentage for bupe period, or just the pills? I ask because I found the newer "film strips" to have a better efficacy than the pills. -clean now, just curious.

Supposedly the film is another 20 percent more efficient, according to my doctor.
This would make it around 50% bioavailability I think.

I'm not sure I believe it or not, but even if true, it still doesn't change the profile very much.

 

[Africanus]

I understand that, and how it causes a ceiling effect. I'm just confused about how sources say that the 2-4mg ceiling effect is for respiratory depression, whereas there seems to be a separate higher ceiling effect for the blockade effect and withdrawal.

I'm surprised at how difficult it still is to get accurate information on Suboxone. Once I read that the article, journal, or website says that IV use of Suboxone will cause precipitated withdrawal due to the naloxone in it, the rest of the information loses its merit to me. It's hard to comprehend why naloxone was put in Suboxone when there was already published data saying that buprenorphine has a higher binding affinity than naloxone. It may be even harder to comprehend how Doctors still think that patients cannot IV Suboxone, so they will only prescribe Suboxone and never Subutex.

Exactly, no one actually knows anything real about it, its like hit and miss trying to get it to work, unless you just drown yourself in it, 50mg a day or something.

Though when I was put in the film they gave me an information leaflet that essentially admitted you could IV suboxone and get somewhat high.