Bupe Switching from Subutex to Butrans--The Math Doesn't Add Up!

[dhopeless]

I posted a thread last December about my sub doctor's increasingly strict policy's and statement that "This new year is going to be a nightmare." Over the past few months my doctor has cut me down from 3 8mg Subutex tablets per day to 2 tablets per day. Every month when I go in he tries to hand me a pamphlet about Butrans, the new transdermal buprenorphine patch indicated for chronic pain. Last week I went in for my appointment, and he gave me a script for 60 pills, so my taper is now done. He claimed that once I'm at this dosage (16mgs/day), I can easily switch to the Butrans patch which is less tightly controlled than my Subutex. He said I could come in less often, probably once every 3 months and that my general physician could prescribe it as well. I told them I looked into it a little and was not impressed with what I saw. I also told him that Subutex works for my pain, I have been on it for over 3 years, and am comfortable with it because I know it works. But I told him I would look into it again, so today I did.

The patches come in 3 different strengths; 5, 10 and 20mcgs per hour (Micrograms, NOT milligrams). So assuming I slapped on a 20mcg patch, I'd be getting a total of .48mgs of buprenorphine over 24 hours. I am currently taking 16mgs of buprenorphine a day...so in order to get an equivalent dose, I would need to slap on about 33 patches! Okay, so let's take bioavailability into consideration. If you take your Subutex as prescribed, sublingually, and assume that you are getting about 30, maybe 40% of the drug, you're brain is actually getting between 4.8 and 6.4 mgs of buprenorphine a day. So that means you would need to wear between 10 and 14 of the 20mcg patches at a time! Am I the only person that thinks that is a little excessive? Also, I should note that I either inject or snort all my pills, so I would need at least double that!

Now my doctor claims that he had a patient taking 16mgs of Subutex or Suboxone a day for sever chronic pain and successfully switched this guy over to the patches... My only guess is that patient must have been selling all of his pills, or taking minuscule amounts of them. So, am I missing something here? I'm pretty sure I did the math right. In fact, I know I did. Can anyone offer me an explanation? Or is my doctor just dangerously misinformed? It wouldn't be the first time. 8(

 

[Ohayou]

I don't understand it, but there must be some weird formula for swicthing someone to the patches because, you're right: adding up the mcg per hour never equals even close to what the subutex dose was. So I don't know, but when I was switched from 1mg a day of suboxone to 10mcg/hr butrans, I only had minor WD's while the plasma level peaked on days 1,2 and 3. It's very strange how 1/10th of a mg of patch bupe somehow equals 1mg of sublingual bupe.

 

[Fire&Water]

You really should try to taper down on yer' dose...I have been on Subutex for years & I know that high a dose does diddly for pain. I agree you should stay on the tablets, but if you really wanted to you could get your dose down to a 2 mg. tablet
1 mg. of subutex can do alot more for your pain than 16 mg's (if you get your tolerance down) It is way to much Bupe'

 

[Ohayou]

You really should try to taper down on yer' dose...I have been on Subutex for years & I know that high a dose does diddly for pain. I agree you should stay on the tablets, but if you really wanted to you could get your dose down to a 2 mg. tablet
1 mg. of subutex can do alot more for your pain than 16 mg's (if you get your tolerance down) It is way to much Bupe'

Hai.

 

[dhopeless]

I don't understand it, but there must be some weird formula for swicthing someone to the patches because, you're right: adding up the mcg per hour never equals even close to what the subutex dose was. So I don't know, but when I was switched from 1mg a day of suboxone to 10mcg/hr butrans, I only had minor WD's while the plasma level peaked on days 1,2 and 3. It's very strange how 1/10th of a mg of patch bupe somehow equals 1mg of sublingual bupe.

Were you taking the Suboxone sublingually as prescribed? If so, you were actually getting maybe .3mgs a day. So on a 10mcg/hour patch at the end of the day you would have gotten around .24mgs in your system...assuming transdermal bioavailability is 100%...which I doubt it is. Damn this gets complicated. Anyway, if that were true then that it would make sense that you would not have much trouble switching over. But someone like me, who takes 16mgs a day would likely have a horrible time switching over. BTW where you taking the Suboxone for pain?

 

[dhopeless]

You really should try to taper down on yer' dose...I have been on Subutex for years & I know that high a dose does diddly for pain. I agree you should stay on the tablets, but if you really wanted to you could get your dose down to a 2 mg. tablet
1 mg. of subutex can do alot more for your pain than 16 mg's (if you get your tolerance down) It is way to much Bupe'

I know, and completely agree with you. I am trying to cut my dose down. I was slamming 16mgs a day last month and since I got my bottle a week ago I have cut that down to between 10-12 mgs a day. I feel crummy a lot of the time and have less energy, but when I do dose I seem to feel it more and it seems to do more for the pain the lower I go. I am trying to get down to the lowest amount possible, which I'm guessing will be about 4mgs for me because I have been on this stuff forever and know myself. In my earlier days on subuxone, I remember when I started snorting them instead of taking them sublingually, I could make one pill last 3 days and I felt jammed all the time. That's the point I am trying to get to now.

 

[Ohayou]

Hai, i took as prescribed, and your ammended math would be correct dhopeless. I still don't get it, do you? haha. I was taking suboxone for ORT from methadone, I was put on Butrans because my doctor believed it was easier to "jump" off of than the sublingual doses which i was ready to do. Butrans is not prescribed for this but my doctor did an off-label thing.

 

[dhopeless]

Hai, i took as prescribed, and your ammended math would be correct dhopeless. I still don't get it, do you? haha. I was taking suboxone for ORT from methadone, I was put on Butrans because my doctor believed it was easier to "jump" off of than the sublingual doses which i was ready to do. Butrans is not prescribed for this but my doctor did an off-label thing.

How much Suboxone were you taking and what exactly is ORT? And what strength of butrans were you put on? And what were the results?

 

[Ohayou]

Well, I was on 1mg a day sublingual film (so half of the 2mg/0.5mg strips) Suboxone.

ORT is "Opiate Replacement Therapy".

I was switched over to the 10mcg/hr Butrans patches and was took 1mg a day for 3 days until the patch fully kicked in.

I eventually cut the patches into halves, then fourths, and weened off. Withdrawal was still difficult but not nearly as bad as the sublingual tabs and strips were for me WD wise. I have since relapsed and have started using the patches again.

 

[dhopeless]

Well, I was on 1mg a day sublingual film (so half of the 2mg/0.5mg strips) Suboxone.

ORT is "Opiate Replacement Therapy".

I was switched over to the 10mcg/hr Butrans patches and was took 1mg a day for 3 days until the patch fully kicked in.

I eventually cut the patches into halves, then fourths, and weened off. Withdrawal was still difficult but not nearly as bad as the sublingual tabs and strips were for me WD wise. I have since relapsed and have started using the patches again.

I can see how a patch may be a better choice for maintenance than pills. Pills have a higher chance of being diverted, and you can take more if you want to, which would escalate your tolerance and cause you to step backward rather than progress in your recovery. I'm sure eventually something like a patch or implant will replace buprenorphine tablets, but I hope it's not for some time. So it makes sense that your doctor would do that. I like having control over my dosage, as I use it for pain and some days I do not need as much as other days. For example, yesterday I slipped on the ice and really hurt my back which is already messed up. That's why I take sub in the first place. So I took an extra 2 mgs to take the pain away and it worked. I think I'd have to go through some stupid and complicated extraction process to do that with a patch, defeating to point of being on the patch. I find it interesting that you were able to switch over that easily. And it turns out that transdermal bupe has a 50% b.a. So that means you were getting half of what my original math was. However, one of the best things about bupe is that you can jump from a high dose to a much lower one and experience little agony compared to a full agonist opiate. So I can see how that could work for some people. I think I'm starting to understand this a little better. But I think I'll stick with the pills.

 

[Znegative]

The patch seems like a real good way to taper off when you're ready IMO. I've been on 1mg of suboxone for about two months now. I split my dose into .5 in the morning and .5 in the evening. I'm totally stabalized on it now, I don't wake up with mild withdrawals or anything, but usually towards the late afternoon I just start anticipating taking my next dosage of suboxone. With the patch you wouldnt have to think about dosing all the time, and you could taper yourself really smoothly I imagine. When it comes the time to get off bupe for good I may try this out.

And 50%BA! That's surprisingly high, though I'm pretty sure fentanyls transdermal BA is really high too. It's just a weird concept, I always assumed transdermal would be a shitty ROA, but apparently it's quite the opposite