Opioids Belbuca 150mcg (buprenorphine buccal film) Effective for Dilaudid Withdrawal?

[Prescottdave]

Hello, I have been on Suboxone 2 MG Sub Film four (4) times a day or 8 MG per day. As per my doctor I have used it for pain for 3 years. For various reasons I want to switch to Bellbuca and I have yet to ask my prescribing doctor. The issue is The conversion as I saw it : To get to 8 MG Suboxone you would need 8000 mcg Bellbuca. Why would this even be worth the trouble for me (Switching)? Stopping or lowering Suboxone can cause withdrawal especially since I have been on Suboxone so long. The numbers do not add up and on paper it looks like it would not be an option unless I want to taper my Suboxone but am I missing something that could validate a better conversion such as absorption (Even though I already take Suboxone Sublingual, OR maybe something else the drug company can say or some proof. Any Answers?

Firstly I would like to answer your question and then respond to several statements made in this thread regarding the BA of bupe in the medication Belbuca. Belbuca is only indicated by the FDA to treat moderate to severe pain requiring around the clock pain management. It is not indicated for ORT and you would be unable to get it prescribed as such. If you want to taper down to a low dose of bupe maybe to get off opiate maintenance Belbuca is not legally permitted to be used in this type of situation.

To taper down off high doses all one needs are the 2 mg suboxone films. With these you can easily cut out 100mcg doses. You can also use a liquid dosing technique to get down to literally 10 mcg. Now if you want to be on a low dose of bupe long term for pain management then belbuca may be an option though likely expensive and hard to get covered by insurance.

Lastly the SL BA of bupe in belbuca is only slightly higher then suboxone. It is higher because the medication is a strip that attaches to the side of your inner cheek. With this form of buccal dosing the drug is slowly and completely absorbed compared to suboxone. Suboxone doses are many times wasted because the client may swallow a small portion of the medication. This is less likely with belbuca. 100 mcg of bupe in belbuca is equal to maybe 150 mcg of bupe in say tamagesic or suboxone. If you want opiate replacement treatment using buprenorphine stick to bupe mono or suboxone. If you want low dose pain management that is less sedating and longer acting then a full agonist opiate check out belbuca. If I wanted pain management using bupe I would go with butran patches which are much stronger, more commonly used and more likely to be covered by insurance

 

[vpasqual123]

I am not taking Suboxone for Opiate Management or ORT. My doctor has vast experience and knows Bup itself could help pain so I take it for pain.

 

[Prescottdave]

I am not taking Suboxone for Opiate Management or ORT. My doctor has vast experience and knows Bup itself could help pain so I take it for pain.

Suboxone is only approved for opiate replacement therapy by the FDA. Meaning it is illegal for your doctor to prescribe it to you primarily for pain management. So you may tell yourself and your doctor that you take it for pain and that may be true but in the paper work for your treatment and the paper work that is submitted to the DEA it will show you are taking it for MAT. Otherwise your doc risks loosing his license. If you don't believe me take a look at your medical records, call your insurance, the pharmacy or take a look at your prescription bottle. It does not say take 8 mg twice daily for pain. If it does you may be out of a doctor before long. You can ask the pharmacy what the suboxone is being prescribed for. You can take a quick look at the DEA and FDA website regarding suboxone prescribing.

This is actually a really basic fact. The same goes for narcotic pain meds. Doctors can not prescribe them long term for opiate replacement therapy. If they did they would risk their license. Now they may prescribe them for pain but underneath they may also know that you actually need them mostly for maintenance. On paper though it has to stick to the rules even if you think you are special unfortunately your not. I say this with a number of years working in addiction treatment and working with clients on butran patches. For doctors to be able to prescribe suboxone they have to take a completely different 8 hour class. This class is a certification to be able to use suboxone as an ORT. This information is submitted to the DEA. After that the DEA knows that your doc is a prescriber of suboxone a medication only indicated in the treatment of opiate addiction. This 8 hour class is not required for prescribing belbuca or butran patches.

 

[Treefa]

Ok, this is why I avoid pain clinics like the plague. I'm so afraid they're gonna force me off opiates and on to bupe, or some other half-ass, quarter-ass...no ass at all pain meds. And then i'll be SOL if I don't do what they say.
If I thought I needed bupe, or that it would help my particular pain in any way, i'd go to a sub doctor and get some 8mg subutex. Those shits can be expensive so IMHO a higher dose bupe product is the ONLY way to go, unless you've got as much money as the Clintons, or something.

Buperenorphine can do some good for some types of pain, but if you've been on dilaudid for a year or more I kinda doubt .175mcg of bupe would do jack shit. Maybe if you take it like 2-3 times a day with pain meds on top it could have some synergistic effects, I've expiremented with this in the past with tiny doses of subs. So-So results...not promising, but in a pinch it'll help stretch my meds a little longer.

I tried the Bunavail buccal film (Rx'd for addiction, I guess) and it worked at least as good as suboxone, but tasted a lot better, and it was kinda cool how it stuck to the cheek.

 

[Prescottdave]

Actually as far as i know Treefa you would be more likely to get a higher dose of a narcotic at a pain clinic compared to a basic family practice/local health clinic. Unfortunately these days with changes in prescribing practices I have no idea what happens at some of the pain clinics. Usually a doc will write a referral to a pain clinic if they do not feel comfortable prescribing high doses of opiates. Also in terms of the supposed price of sub or bupe mono most insurance companies cover it partly or completely. My insurance covers my sub. So I have not paid a single dollar in the past two years on my suboxone prescription. The newer generic bupe mono 2's and 8's are cheaper then suboxone films and possibly the tabs. They are also smaller.

 

[vpasqual123]

WE are well aware of this!

 

[vpasqual123]

WE know all this! My doctor has been in business 40 years and like many sometimes he/she will side track the rules. Also like many just google the words "Suboxone for long term chronic pain management and read some testimonials and what others are saying. He/She prescribes it properly and yes I am on the DEA list. That does not stop US from using it for a secondary reason. Why are you so concerned? A doctor should just be happy that it works for me. I will most likely go on belbuca soon and taper down Suboxone.

 

[Prescottdave]

WE know all this! My doctor has been in business 40 years and like many sometimes he/she will side track the rules. Also like many just google the words "Suboxone for long term chronic pain management and read some testimonials and what others are saying. He/She prescribes it properly and yes I am on the DEA list. That does not stop US from using it for a secondary reason. Why are you so concerned? A doctor should just be happy that it works for me. I will most likely go on belbuca soon and taper down Suboxone.

I see what your saying. So you take it off label for pain but your are enrolled in an opiate replacement therapy program or seeing a doctor for addiction treatment. I guess I was confused at first. Your doc is likely not side tracking any rules . Do you see what i'm saying? Will your insurance be paying for the belbuca in full? I think it literally just got released no less then a year ago.

 

[PassivePanda]

Welp, thread seems to have derailed a bit but I'm one to enjoy good discussion.

I'm once again inducting, in order to get off heroin. I have had PWD once utilizing these films. I really feel like using one or two Belbuca before inducting anyone is a good measure.

I wish opiates weren't so challenging to resist.
With a snotty nose, pain in my legs and lethargy comparable to the plague, here I am again.

I've managed to stay out of jail, the nuthouses and beyond somehow, but this feeling that something was going to happen was pervading, and again I am here to make a change in my life. This is I believe the fourth time now that I have inducted and I feel positive. I hope anyone reading this can share a glimpse of sobriety with me and do their best to get off whatever their doc might be.

I seem to alway induct at 22 hours. It's funny that this thread has allowed me to document that.
I hope the best to everyone that posted and everyone that cares. I would really like to stay off opiates permanently after this bout of withdrawal.

Thanks blue light, for all of the harm reduction information I've received, and thank you for offering me a place to document and 'release' everything that's been going on.

Much love, and good luck to all who want to be well... And even those who don't.

Panda

 

[vpasqual123]

Am I OK too post

 

[vpasqual123]

It is prescribed for opiate management but has a second useful help with my pain.

 

[vpasqual123]

Belbuca and suboxone for pain

I see what your saying. So you take it off label for pain but your are enrolled in an opiate replacement therapy program or seeing a doctor for addiction treatment. I guess I was confused at first. Your doc is likely not side tracking any rules . Do you see what i'm saying? Will your insurance be paying for the belbuc in full? I think it literally just got released no less then a year ago.

Yes I am seeing a doctor who is a addiction treatment specialist. However, my situation is very complicated and in truth I am really only "dependent",
BUT due to no fault of my own, 30 years with major illnesses five major surgeries and I do not know how many other hospitalizations for other indirect or direct reasons to my illnesses. I found in lower doses Suboxone helps my pain but when I have pain not controlled by the Suboxone (which is less since I went on Suboxone) it is necessary to be on IV Dilaudid for that hospital stay only. When released i go home and go back on my Suboxone and I am fine. I am not a drug addict or drug abuser I am "dependent" on it for legit reasons. it has so many more pros than cons at least for me and my situation. It can be frustrating when I am in the ER or given a doctor who does not know me. The red flag can go up "Suboxone" OH NO BAD BOY"
I give letters and documentation I have and ask them to talk too my prescribing doctor and then all is fine. In the mean time I suffer. Long story short about a year and one half ago I went to the ER and the ER doctor decided I would not stay. I argued because I am my best advocate to no avail. I go home and then the next day I am rushed to the hospital and had to be admitted to the ICU for 5 days!!! I know my situstion is in the minority but all of this is so unfair and something has to be done about it....

 

[kleinerkiffer]

^Please use the edit function, so you don't have to triple post!

 

[PassivePanda]

Hello again everyone,

I figured I would continue to post about my trials and tribulations when it comes to using, relapse, inducting, and so forth.

I've found myself reading entire threads to just gain as much knowledge as possible - it's amazing, the people that post have no idea what they're offering for others.
As I've stated before, this website is incredible and I'm so very grateful for everything I have learned in my relatively short time here. A few suboxone threads have offered me hope - something a recovering opiate addict is rarely blessed with.

Anyway, it has been 8 days without using any heroin. (August 27). I inducted on August 11th, went about 3 days, and relapsed yet again with black tar heroin. (August 14) This is where things took a very interesting, albeit fortunate, turn.

The friend of mine with BTH was consciously aware that he had contributed to my relapse, and decided to take it upon himself to taper me off, which, at the time - really - pissed me off.

Each day he would only allow me certain quantities, lesser each day. This went on for about five days. On the fifth day, I was down to about a point to smoke (not much, at all) and by then, I had already noticed a reduction in my tolerance, with no withdrawal symptoms in between.

I've never had the willpower to taper using full agonist opiates (explaining why I didn't bother tapering my dilaudid in the first post) but this individual literally just forced me to.

Anyway, after the initial break from using (via suboxone) on August 11th-14th, I relapsed from the 14th to the 19th (tapering my heroin use daily as described above). My girlfriend has been through a lot with my use and withdrawal, and I decided I'm at a low enough tolerance to induct again, and finally beat heroin. So I did.

This time I was able to induct at 20 hours because I had used much less than normal. There was still a pronounced period of withdrawal, but I was able to use only 4mg of suboxone (compared to 12mg after my multiple month long use) on the first day.

I've been using suboxone and following a poplar taper regimen of a 25% reduction in dosage, although I'm reducing 25% every two days as opposed to 4-5.

So far, this is the longest I've been off of heroin since I started using it, and I feel great. The physical symptoms were over fairly quickly (thanks to my friends 'forced willpower' in tapering off).

Now I just have cravings, lethargy (that is getting much better) and an overall depressed mood. I'm excited to see where things go in my life without heroin. I'm seeing an addiction therapist who I really like. My family is beginning to trust me and not worry anymore. I feel good about myself.

This particular post didn't offer a whole lot for people to work with, but it has been very cathartic for me. I'm really grateful for bluelight.

In the meantime, I'm going to work on attaining 50 posts, after that, anyone is welcome to PM me with questions or comments. I'm glad to help, talk or offer insight.

Be well, bluelighters!

 

[JamesBond007]

I think the doses you have are a little to small for what you are wanting to achieve.

Induction doses for buprenorphine ORT therapy usually begin at 2-4mg which is around 13-26 of your 150mcg films at once...... And that's just the induction.

Suppose you need 8mg (which is a very conservative estimate based on the amount of hydromphone you describe using) then that would be nearly 50 of these strips at once. I don't know how many you have but unless you have literally thousands of them i don't think it's doable.

You really need subutex/suboxone which contain bupronorphine in mg quantities.....

Edit.....I also think 15 hours is pushing it for avoiding PWs. I would try to wait at least 24 hours to be on the safe side.....

Good luck mate....

Yea these belbuca SUCK. I normally take 2mg of Suboxone or Subutex a day and yesterday i took a 600mcg belbuca for the first time and i felt like SH#T.
600MCG IS .6MG SINCE 1000MCG IS 1MG.
Like i Said i normally take 2mg a day of subutek when i come off opiates and it would take 4 of these 600mcg of belbuca to equal 2mg of subutek or Suboxone. I like subs but the belbuca did NOT work for me personally.
I was in wds all night couldn't sleep keept shaking cold.
I usually wait 18-24hours before taking subs and i waited with belbuca and STILL FELT LIKE SH#T.
I HIGHLY HIGLY RECCOMEND YOU GET YOUR DR TO WRITE YOU SUBUTEX OR SUBOXONE AT LEAst 2MG daily. I can make a 8mg Suboxone or Subutex last me five days. Since i take 2mg a day that would mean i would have to take more than 10 belbuca!

 

[Prescottdave]

Yea these belbuca SUCK. I normally take 2mg of Suboxone or Subutex a day and yesterday i took a 600mcg belbuca for the first time and i felt like SH#T.
600MCG IS .6MG SINCE 1000MCG IS 1MG.
Like i Said i normally take 2mg a day of subutek when i come off opiates and it would take 4 of these 600mcg of belbuca to equal 2mg of subutek or Suboxone. I like subs but the belbuca did NOT work for me personally.
I was in wds all night couldn't sleep keept shaking cold.
I usually wait 18-24hours before taking subs and i waited with belbuca and STILL FELT LIKE SH#T.
I HIGHLY HIGLY RECCOMEND YOU GET YOUR DR TO WRITE YOU SUBUTEX OR SUBOXONE AT LEAst 2MG daily. I can make a 8mg Suboxone or Subutex last me five days. Since i take 2mg a day that would mean i would have to take more than 10 belbuca!

Cutting down from 2mg-0.5 mg of bupe will result in WD's. It's not that the brand of Belbuca sucks it is just that your dose was 1/4 of what you usually take. When tapering bupe I would go for a drop of 0.5 mg every 5-7 days. Dropping your dose over 0.25 mg results in WD's.

 

[jamesBrown]

Suboxone is only approved for opiate replacement therapy by the FDA. Meaning it is illegal for your doctor to prescribe it to you primarily for pain management.

I'm a little confused. Are you saying that because a drug is only approved by the FDA for certain "ailments"....if it is prescribed to someone for an "ailment" other than what the FDA has approved, it is illegal? Or are you saying that that is true, but only in opiate replacement therapy?

I ask because I am prescribed Marinol, which is only approved by the FDA for cancer and AIDS patients, but I do not have either conditions. I simply have debilitating pain that causes inconceivable nausea, thus the need for Marinol. And I also happen to know for a fact that my doctor is completely legit, highly respected, and definitely does not misrepresent the reason for prescribing me this schedule 3 medication on any forms related to my treatment.

 

[tacodude]

Marinol is for nausea and appetite stimulation usually due to cancer treatment side effects, but not only for that specific nausea and appetit stimulation.

 

[jamesBrown]

Marinol is for nausea and appetite stimulation usually due to cancer treatment side effects, but not only for that specific nausea and appetit stimulation.

Well according to the FDA it actually IS only for cancer and AIDS patients for the treatment of, as you said...appetite stimulation/nausea.

I was even denied coverage for my Marinol prescription by 3 separate insurance companies because of this exact reason. The denial letters even quoted the FDA restrictions. Trust me, I would most definitely NOT want to have to pay the whole $450/month it costs for my Marinol prescription if I didn't have to. But the insurance companies cite the fact it is not technically FDA approved for me since I have neither cancer nor AIDS so they can deny me.

 

[tacodude]

I've had it before insured it can't be that hard.