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Opioids Is Suboxone the only substitute?

Altered Perception

Altered Perception

Bluelighter
Joined
Dec 13, 2010
Messages
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On a big Island surrounded by sharks.
I have never used Suboxone before and I have some questions...

I take Oxycodone everyday for 4 years now. I am on a 80mg dose and I was wondering is the withdrawals from suboxone just as severe as the withdrawals from Oxycodone?

Does all Suboxone have naloxone in it? I don't want to risk using naloxone as I have a medical condition known as Autonomic Dysfunction which leaves me very sensitive to many substances that act on my Autonomic Nervous System, even with opiates it took me over a year of desensitizing and I still ocassionally end up in the ER with adverse effects. So I wanted to know what are there any substitues for suboxone which don't have naloxone in it ?

Because it took me so long to desensitize myself to Oxycodone I don't want to undo all my hard work by going cold turkey, but I definetly want something to help me reduce my dose to perhaps down to 10mg from the 80mg without having too much withdrawal. I started Oxycodone because of chronic pain but now some days I am pain free but I still take Oxycodone just because I crave it and this is a waste of medication so if I started on suboxone for most of the week but then suddenly developed pains can I just take a dose of Oxycodone or will the Oxycodone be inefective due to the naloxone?

So I guess my final question is can you just take a normal dose of pain killers when necessary whilst you are on suboxone?
 
Nevermind I just read about Subutex, its like Suboxone minus the naloxone, sounds like exactly what I need but I am still confused...If Buprenorphene is just another opiate and also has pain relieving effects how is it effectively used in the management of opioid dependence ? Isn't it like replacing Oxycodone with Hydrocodene or something?
 
Altered Perception said:
Nevermind I just read about Subutex, its like Suboxone minus the naloxone, sounds like exactly what I need but I am still confused...If Buprenorphene is just another opiate and also has pain relieving effects how is it effectively used in the management of opioid dependence ? Isn't it like replacing Oxycodone with Hydrocodene or something?
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Buprennorphine is a partial-agonist opiate meaning it doesn't bind to all of your Opiate receptors (including the one that causes euphoria) however does bind to some. It has a VERY strong binding affinity. With that being said, if you decide to try to take other opiates, they will not be able to get you high because they can not overcome the strong binding affinity of Buprenorphine. It really doesn't have any pain relieving benefits but the first few days or week you're on it you should be able to feel a bit of an opiate high; especially the first day. After that, your tolerance sky rockets and it just helps prevent withdrawals. You will start to feel more normal then high. So it is a very good drug to help but you have to be committed. Some people stay on Suboxone maintenance for most there life and others will take it for a period of time and then taper off it. Tapering off could result it relapsing though when you are off the Suboxone. I just realized that I was saying Suboxone but the same goes for Subutex.
Hope thats helps
 
Thanks so much for explaining it to me, now I understand it much better. I guess it seems like its not suitable for me because I wanted to use it on and off in between the Oxycodone. For example lets say I am pain free for 5 days of the week so I take Subutex on those 5 days but then for 2 days I suddenly get bad pain again so I go back to oxycodone for 2 days and then back to Subutex again, can I do that ?
 
Bupe w/d isn't too bad if you taper down slow. Easier than Oxycodone W/D, but lasts a little longer.

If you take small doses of subutex (<1mg) , then you can switch back and forth w/o too much discomfort. First, to get your body inducted to the bupe, you will have to stop your oxy for about 24 hours before your first bupe dose.

The bupe will help w/ WD and cravings. Try to give about 12 hours between your last sub dose and your following oxy dose.

Please note, this only works if using small doses or else you will get no benefit from the oxycodone. It can be a little tricky too, cause if you take too much bupe, then the oxy might not do anything and you risk getting Precipitated W/D when you take your following oxycodone dose. It's a very delicate balance.
 
Wait 24 after your last Oxy dose for your induction, which is the first time you take sub.
But, after that, you can get into a routine of
1. Low (<1mg) bupe
2. Wait 8-12 Hours
3. Full agonist
4. wait 8-12 hours
5. Low (<1mg.) bupe
I did that routine for months.
Nice part is, if you're broke for the day, just skip your full agonist for the day, and you won't get sick.
 
You can't just jump into that schedule. It takes a lot of work to get there.

First, you have to do suboxone/subutex induction(For 80mg/day of Oxyc I would estimate 2mg. ), which involves abstaining from your opiate of choice for ~24 - 48 depending on drug. (Suboxone/subutex won't be able to help you with your tapering. )


I usually tell people to wait until it feels like you couldn't possible feel any worse. Hold out as long as you can. (Cause PWD will take what you think is 10 on a pain scale, and turn it into a 2) There's a test to determine your state of WD, some docs make you go thru it before induction. It's tricky to pass when not sick.

Then you have to taper your bupe dose down low enough, usually anything lower than 1mg/day is good. But for different ROAs, you have to go as low as .5mg/day. This could take days, or months depending on how high you started and how fast you taper down.

Once you're low enough, try an opiate 12 hours after your bupe dose. Don't expect 100%, but if you feel most of it, then you're ready. If not, lower your bupe dose a little until you get it right. It's a tricky balance, but it keeps you well and allows you to chip a little without damage, assuming you don't overdue on that "chipping" dose.
 
Subutex will not work for you OP. You will risk precipitated withdrawls by switching from oxycodone to Subutex.

Also, the Subutex has very little pain killing effects, especially compared to oxycodone.

Plus, even if you managed to work out the timing to avoid precipitated w/d, Subutex will raise yourtolerance to oxycodone, or at least keep it the same, but it definately won't lower it. Subutex is a very potent drug even though it has little euphoria, by regularly taking subutex, you will continue to raise your tolerance.

IMO/E, you're better off just tapering down the oxy to where your comfortable. And on days you don't need it for pain, just take as little as you need to not get sick. Since Subutex won't get you high anyway, there's really no difference between taking subutex, and taking the minimum dose of oxy needed to keep you from going into w/d. And as stated before, you're more likely to experience some type or degree of w/d if you start taking subutex, b/c you'll need to be in w/d everytime you switch from oxy to subutex....

Just my 2 cents from years of subutex, oxy, H, and Methadone...goodluck to ya
 
Don't have time to read through the whole thread, just the original post, but here's my oppinion:

I don't know your medical condition but I would say that I doubt that you would have to much trouble transitioning from oxycodone to subutex, as they are both opioid derivatives of the same alkaloid, Thebaine. Buprenorphine is known for being a bit more stimulating than oxy and hydro, but it is in no way speed.

As for withdrawals, I imagine the subutex (buprenorphine) would be worse given your current tolerance, 80mg oxycodone. I also get the feeling that you are not attempting to defeat the time release, which means that your overall tolerance for a single dosage is really low. Suboxone/subutex would probably be effective if you kept yourself at a microgram dosage. I would start off with .25 mg, and work my way up from there. The problem with bupe is that it's a partial agonist, and it has a cieling effect. This means, that past a certain dosage (which is constantly being debated, but it's somewhere around 2-32mg lol) no more opiate effects can be squeezed out of it.

Also, buprenorphine binds so tightly to opiate receptors, that at high dosages (usually over 2mg sublingual), it will block other opiates from connecting to those receptor cites. This can be a bad situation if you are in major pain, as attempting to break through this blockade can lead to respiratory depression. I was in the hospital in late August-mid October, and they had to give me a procedure which required fentanyl for anesthesia. I had been taking 4mg of suboxone at the time, and I told the doctors this, but they ignored me, and said fentanyl was strong enough that it wouldn't matter. Sure enough I was completely conscious through the whole procedure.

I've heard success story's regarding buprenorphine in addition to full agonist narcotics, but they always kind of boggle me. The best way to try and make it work is to never use more than 2mg of buprenorphine, because at that dosage, you can still usually feel the effects of other opiates
 
You can jump from any short acting opiate at any dose to suboxone w/o PWD. Induction might suck a little, but as long as you give it time(24-48hr), you'll avoid PWD. Now, longer acting opioids like methadone need much longer.

If after induction, you're sub dose is low enough(<1mg), you do not need to be in WD at every switch. This way, full agonists can be taken between your bupe doses.

Potential problem for the OP is, he's used to his dose stopping pain. If he lowers the dose really low, or quits oxycodone and switches to bupe, his pain will be much more pronounced.
And his idea of using bupe to help lower your oxycodone tolerance, which still taking oxycodone, won't work that way. You have to go thru induction(PWD) to start using bupe. No way around it. Just try and sedate yourself best you can while waiting. After induction, you can still take oxycodone when needed for pain, but if you need it everyday, then that kinda defeats the purpose.

Honestly, if you're not feeling pain, that means the pills are working. I;m guessing you would have a RX if a doctor didn't think you needed it. Why mess with that ?
 
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That would work, but he would need to start at a small dose. Like 10-15mg/day.
I don't know if OP is in USA, but getting methadone prescribed for pain is tricky here(there?)
 
There is also the Butrans patches. No nalaxone, just plain buprenorphine. They come in 5mcg, 10, and 20. Many people use them to treat severe chronic pain..so at only 80mg of oxy a day, a 5-10 mcg patch would most likely kill whatever pain you'd be having that you previously would have had to take oxy for, and whatever withdrawals.
 
benzo bars said:
Buprennorphine is a partial-agonist opiate meaning it doesn't bind to all of your Opiate receptors (including the one that causes euphoria) however does bind to some. It has a VERY strong binding affinity. With that being said, if you decide to try to take other opiates, they will not be able to get you high because they can not overcome the strong binding affinity of Buprenorphine. It really doesn't have any pain relieving benefits but the first few days or week you're on it you should be able to feel a bit of an opiate high; especially the first day. After that, your tolerance sky rockets and it just helps prevent withdrawals. You will start to feel more normal then high. So it is a very good drug to help but you have to be committed. Some people stay on Suboxone maintenance for most there life and others will take it for a period of time and then taper off it. Tapering off could result it relapsing though when you are off the Suboxone. I just realized that I was saying Suboxone but the same goes for Subutex.
Hope thats helps
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A fair amount of what is said here is incorrect. Suboxone contains buprenorphine and naloxone. Buprenorphine is a partial mu agonist with a high affinity for the receptor. A partial agonist is an agonist that has only a partial effect upon the receptor, not that it only binds to part of your opiate receptors as as was previously stated. Think of the opiate receptor as a door: when buprenorphine binds to that door, it only opens the door halfway. Hence, buprenorphine is a partial mu agonist.

Naloxone is added to prevent intravenous abuse of Suboxone. It has no oral activity.
 
lazylazyjoe said:
Honestly, if you're not feeling pain, that means the pills are working. I;m guessing you would have a RX if a doctor didn't think you needed it. Why mess with that ?
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Because I used to get the same pain relief on 10mg, but without all the added side effects brought on by taking 80mg. So I want to go back to that lower dose and also my doctor is getting all worked up about me being on a higher dose and he feels uncomfortable prescribing it more often than he used to
 
Znegative said:
I also get the feeling that you are not attempting to defeat the time release, which means that your overall tolerance for a single dosage is really low.
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When you say time release, are you refering to the slow release Oxycontin? The Oxycodone I am using is 20mg capsules containing fine white powder of instant release "Oxycodone Hydrochloride".

The reason I can't use Oxycontin slow or extended release is because how sensitive I am and all the adverse reactions I've had which only last for 1-2 hours thank God, otherwise having a long lasting adverse effects on an extended release would have been much more risky.

Thanks for all your advice.
 
waldo777 said:
Subutex has very little pain killing effects, especially compared to oxycodone.

Subutex will raise yourtolerance to oxycodone, or at least keep it the same, but it definately won't lower it.

by regularly taking subutex, you will continue to raise your tolerance.
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Ouch! Those are major deal breakers and you've managed to put me off the idea right away
 
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