Bupe Prescribed Butrans patch for pain and buprenorphine for OUD

[rplate81]

Forgive me if this is been discussed, I have not found anything about my specific situation on here yet though.

I am on on 2 mg buprenorphine sublingual tablets prescribed by my primary care doctor for MAT/OUD.

For the last few years I've been having daily chronic pain, so he prescribed me 20 mcg Butrans patches for The Chronic pain

I think I understand how understand how the Butrans patches work. The patch gives out very small increments of the medication through a transdermal system is supposed to be more effective at pain than a higher dose of buprenorphine.

If I am correct, wouldn't me already being on the 2 mg pills not really make the patch effective?? I told the pharmacist that I thought it was a contradiction for him to be prescribing me them both, she agreed with me.

Also, he has it written up I am on the buprenorphine pills for addiction, and the patch for chronic pain. Maybe this is not such a rare thing??

Anything of recreational value out of these patches?? I would be too scared to do it, but extracting the gel and smoking it?? I've never been on any type of patch, but I've heard that when they had the Fentanyl patches you could smoke the gel off of it.

 

[Them Witches]

Patches will not stick to my skin due due my skin oil make-up. After 24hrs the patches only stick to 25% of my skin causing pre-mature withdrawals.

Some people have luck with non-gel patches by folding them in half sticky side out, and absorb them buccally. Under the tongue (sublingual) does not work as well.

The company "Sandoz" makes their generic fentanyl 100mcg (non-gel) patches the same strength as their brand name version. Both generic and brand name contain 16.4mg of active ingredient.

The company Watson makes their generic Fentanyl 100mcg (gel) patches with only 10mg of active ingredient. Not all generics are created equal. Watson is about 38% less.

Sandoz makes the Bustran patches so I would assume they make them as strong as the brand name. With patches always get Sandoz.

My point -- starting off with Sandoz's strength. Then one cannot located them or the pharmacy switches to a "Watson." This will end up bad for the patient regarding having the correct blood plasma levels. This happened to me and I had my doctor disable the Rx immediately. I was not about the continue the process ever again.
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Sandoz 20mcg Bustran generic patches contain 20mg for 7 days.

These companies including "Sandoz" produce generic Bustran patches. Something to look into to find out which companies produce the most active ingredient per patch. The best way to find out is to call pharmacies or call the producing company individually.

• Amneal Pharmaceuticals
• DifGen Pharmaceuticals (manufactured by its subsidiary Aveva Drug Delivery Systems)
• Strides Pharma International
• Watson Laboratories (a subsidiary of Teva Pharmaceuticals)

Personally, wearing a patch for 7 days seems sketchy and towards day 5-7 I wonder how well it works compared to 1-4 days. Best of luck with the patches. You are on the strongest 20mcg patch made
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(A) Interaction with benzodiazepines: May increase buprenorphine-inducedrespiratory depression. Monitor patients on concurrent therapy closely.
• CYP3A4 inhibitors/inducers: Initiating CYP3A4 inhibitors ordiscontinuing CYP3A4 inducers may result in an increase in buprenorphineplasma concentrations.
* Closely monitor patients starting CYP3A4inhibitors or stopping CYP3A4 inducers for respiratory depression.

(B) The Bustran 10mcg patch carries a daily 30-80mme value (this would turn me away immediately)
Prior Total Daily Dose of Opioid Greater than 80 mg of Oral Morphine Equivalents per Day:BUTRANS 20 mcg/hour may not provide adequate analgesia for patients requiring greater than 80 mg/day (80mme) oral morphine equivalents. Consider the use of an alternate analgesic.
It seems difficult to know the exact MME value of Bustran. Tolerance, prior dependence, how the body processes it, and how well the stick to the skin -- all seem to come into play.

 

[Them Witches]

I will leave this alone after this post. By no means am I passing judgement. Said patient mentioned OUD and daily takes 1qty 2mg Bupe sublingual.

Diverting a 20mg patch will wreck said patient's daily physical dependence. It will be difficult to reverse this. Gauging said patient's chronic pain will be even more difficult.

Diverting a 7 day patch in one day with the long-half life of Bupe (3-4qty patches per month) will create a large drop every 3-4 days in blood plasma levels. Continuing to divert 7 day patches will compile quickly leaving things very unpredictable and opens the door for said patient to consult their doctor too soon in "the doctor's predicted treatment plan." The doctor will pick up on this for sure b/c the doctor is very aware of the medication's half-life and monthly quantity. The long half-life of Bupe is very predictable unlike example Oxycodone IR every 4-6hrs. Oxycodone IR has frequent dosage adjustments while dialing in the patient's required/needed daily dosage and how often dosages should be.

Hope this helps in some way and makes some sense.

 

[4DQSAR]

I've mentioned elsewhere, when the first-into-man trials of buprenorphine were undertaken, it was shown that 200-400µg every 6 to 8 hours was the appropriate range for analgesia. It appeared that there is a plateau meaning higher doses provide no additional analgesia.

Now those trials used IV injection so one assumes close to 100% bioavailability so if the current buccal and sublingual formulations only demonstrate around 40% bioavailability, that would be about the same. But I think the important bit is that the analgesic action of buprenorphine only last for between 6 and 8 hours.

I don't know the precice bioavailability of the patches but I seem to remember calculating that they are designed to keep the plasma level of buprenorphine at around the same level as the other formulations.

But I feel the important bit is the duration. Yes, 2mg consumed once a day may be appropriate for analgesia, but as far as I know, in the UK at least it's recognized that the plateau means higher doses offer no benefits except for the duration of action.

 

[rplate81]

Patches will not stick to my skin due due my skin oil make-up. After 24hrs the patches only stick to 25% of my skin causing pre-mature withdrawals.

Some people have luck with non-gel patches by folding them in half sticky side out, and absorb them buccally. Under the tongue (sublingual) does not work as well.

The company "Sandoz" makes their generic fentanyl 100mcg (non-gel) patches the same strength as their brand name version. Both generic and brand name contain 16.4mg of active ingredient.

The company Watson makes their generic Fentanyl 100mcg (gel) patches with only 10mg of active ingredient. Not all generics are created equal. Watson is about 38% less.

Sandoz makes the Bustran patches so I would assume they make them as strong as the brand name. With patches always get Sandoz.

My point -- starting off with Sandoz's strength. Then one cannot located them or the pharmacy switches to a "Watson." This will end up bad for the patient regarding having the correct blood plasma levels. This happened to me and I had my doctor disable the Rx immediately. I was not about the continue the process ever again.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Sandoz 20mcg Bustran generic patches contain 20mg for 7 days.

These companies including "Sandoz" produce generic Bustran patches. Something to look into to find out which companies produce the most active ingredient per patch. The best way to find out is to call pharmacies or call the producing company individually.

• Amneal Pharmaceuticals
• DifGen Pharmaceuticals (manufactured by its subsidiary Aveva Drug Delivery Systems)
• Strides Pharma International
• Watson Laboratories (a subsidiary of Teva Pharmaceuticals)

Personally, wearing a patch for 7 days seems sketchy and towards day 5-7 I wonder how well it works compared to 1-4 days. Best of luck with the patches. You are on the strongest 20mcg patch made
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(A) Interaction with benzodiazepines: May increase buprenorphine-inducedrespiratory depression. Monitor patients on concurrent therapy closely.
• CYP3A4 inhibitors/inducers: Initiating CYP3A4 inhibitors ordiscontinuing CYP3A4 inducers may result in an increase in buprenorphineplasma concentrations.
* Closely monitor patients starting CYP3A4inhibitors or stopping CYP3A4 inducers for respiratory depression.

(B) The Bustran 10mcg patch carries a daily 30-80mme value (this would turn me away immediately)
Prior Total Daily Dose of Opioid Greater than 80 mg of Oral Morphine Equivalents per Day:BUTRANS 20 mcg/hour may not provide adequate analgesia for patients requiring greater than 80 mg/day (80mme) oral morphine equivalents. Consider the use of an alternate analgesic.
It seems difficult to know the exact MME value of Bustran. Tolerance, prior dependence, how the body processes it, and how well the stick to the skin -- all seem to come into play.

Hey!! I just saw this. I never got an alert when you replied. I did try cutting it up into 20 pieces because it is a 20mcg patch and put it in between my lip and gums. I would like to say that I felt almost a full agonist from it, but maybe placebo since I am already on 2 mg which I take every other day. My patches are made by Purdue. I would like to transition to the patches, but I don't want to raise my tolerance, but nor do I want to be in withdrawal if I spaced it out every 48 hours. I have been doing it that way for years, it's the only way I can get some kind of feeling from buprenorphine.

I don't have any say in asking what brand I can get, I've tried it before with other meds and the pharmacy won't help. I have been off of benzos for a long time, so not taking those. My PCP who prescribed me the patches is a newish doctor who doesn't seem that knowledgeable to me, I didn't understand why he prescribed the strongest patches.

 

[rplate81]

I've mentioned elsewhere, when the first-into-man trials of buprenorphine were undertaken, it was shown that 200-400µg every 6 to 8 hours was the appropriate range for analgesia. It appeared that there is a plateau meaning higher doses provide no additional analgesia.

Now those trials used IV injection so one assumes close to 100% bioavailability so if the current buccal and sublingual formulations only demonstrate around 40% bioavailability, that would be about the same. But I think the important bit is that the analgesic action of buprenorphine only last for between 6 and 8 hours.

I don't know the precice bioavailability of the patches but I seem to remember calculating that they are designed to keep the plasma level of buprenorphine at around the same level as the other formulations.

But I feel the important bit is the duration. Yes, 2mg consumed once a day may be appropriate for analgesia, but as far as I know, in the UK at least it's recognized that the plateau means higher doses offer no benefits except for the duration of action.

I snort my 2mg subutex pills every other day, so 48 hours in between. Been doing this for a while now, it's the only way I can get anything out of them. When I have taken it daily I feel nothing and I get no reduction in cravings.... I want to switch to the patch, I cut it up in 20 pieces because it is 20mcg patches. Stuck a piece in between my gums and lip. It felt like I was feeling almost a full agonist, but probably placebo as I have already been on the buprenorphine pills.

 

[Keif' Richards]

Once again @4DQSAR beat me to the punch.

I´m not a doctor, but I am fairly confident I know my shit better than most doctors I have ever spoken with on the subject. To be certified to prescribe Buprenorphine, doctors undergo and incredibly simple, likely online course that they may or may not actually be engaged in. This is an Opioid with incredibly complex mechanisms of action that cannot be learned completely in a day or two.

Like my colleague already alluded to, Buprenorphine can be used to treat pain, but it is only effective in dosages lower than 2mg Buprenorphine per day. Once the dosage is raised past this point, Buprenorphine´s unique pharmacology comes into play. In short, the Mu Opioid Receptor or MOR is the receptor that we are trying to hit. This is the receptor that produces analgesia, euphoria and arguably what makes an Opioid and Opioid. The peripheral receptors like Delta and Kappa have value in certain applications, but not for what we are trying to do.

As the dosage is raised, these peripheral receptors come into play and generally just produce unwanted symptoms that are not beneficial for the pain patient.

If you are on Buprenorphine and require Opioids for pain, the most logical thing to do would be to switch to a different Opioid and forget the Buprenorphine. Otherwise, this would entail cutting out the maintenance dosage and switching completely to the approved analgesic dosages. This ranges from 0.3mg-0.8mg to make up ~2mg Buprenorphinie per day total.

I´ll just be honest, this regimen they´ve put you on makes no sense to me. It strikes me that they don´t have intimate knowledge of this drug, otherwise they wouldn´t have gone for what is a highly unorthodox prescription. It is a lot of headache to simply obtain the same drug that you´re already prescribed.

If 2mg Buprenorphine was not helping your pain, I would be very surprised to hear that an extra fraction of a milligram would somehow be a game changer. That´s not how Buprenorphine works. Don´t feel alone, doctors are less and less educated every day. That is why Bluelight cotntinues to thrive. In a world where junkies on the internet are able to make more rational, evidence-based decisions that these people with 8 years of education, well, what does that say? Nothing good.

You will likely need to pursue something different for your pain. I would even consider lowering your Buprenorphine dosae and experiment with that. It wouldn´t surprise me if that worked better for your pain. If you have any questions about any of this, we are all here to help.

 

[rplate81]

I have heard that about the "training" that doctor's need to prescribe Buprenorphine is like a one day class. I have also heard about bupe under 2mg works more like a full agonist. I've tapered completely off before, but I don't remember it working better at a really low dose, but then again I was not really in any pain on a regular basis.

I would say that there is no chance of me ever being prescribed a regular script for any opioid painkiller ever again. Although I have been to the ER 2x. First time the ER doc offered me Norco, I declined. Second time they gave me a morphine shot, but I had no clue that I was gettting it until the needle was almost in my arm. I was supposed to have knee surgery last year. I told the surgeon that I was on buprenorphine. He said it was all good and that he had many patients on it as well. He offered me I think it was 30 5mg percocets. I didn't have the surgery because my sciatica really flared up and I didn't want to go in unhealthy for surgery.

I was at the pharmacy on two occasions to deal with the Butrans. I told one pharmacist that I thought it was really contradictory the combination of the two and she fully agreed with me. On the other occasion, another pharmacist who is less talkative, kind of shy, thought the same. She didn't literally say it, but I could tell by her body language and the way she talked that she agreed, she told me "it won't hurt to try" So I took that as her agreeing with me.

My PCP is actually a replacement for my old doctor who was really good especially for my insurance, but he left to further his schooling.

I had a referral to a pain clinic about 2 years ago. I ultimately did not go because they made you sign a contract saying that they will take over all of you meds before you can even see the doctor. Also when I talked to the receptionist, first thing she told me was "they don't give out pain meds" I told her that I wasn't looking for any, I was just interested in injections, but I gave up on the PM clinic. It's also the only PM clinic that my insurance covers, so yeah......

 

[maryanne77]

Skip the injections ,especially in the spine . They are dangerous !

 

[pnillyg]

It’s funny they forgot to fill my script and I had two days where I had no buprenorphine. I’m on 2 mg a day. I have a few 20 µg per hour and a few 5 µg per hour patches. I slapped on 120 µg per hr patch for the two days and I don’t think it did anything.

 

[maryanne77]

Wow

 

[rplate81]

Skip the injections ,especially in the spine . They are dangerous

Before my back and legs got fucked from from sciatica, I got Hylarounic Acid injections in both knees about 2 years ago. $1500. They seemed to help for a week or so. I refuse to get cortisone steroid injections though. Those were the first and only thing the doctors and pain clinic were pushing on me. Never ended up going to the PM clinic because they seemed sketchy. I've been researching and talking to people on reddit about the steroid injections for about 3 years now and I still have not seen anyone say that they helped, actually most were saying they made them feel worse.

It's been 3 years since I messed up my knee and back. My insurance sucks so I have had to put it upon myself to seek help with my ongoing injuries/chronic pain. I've been in PT every week sometimes 2x for 3 years. Spent tons of $ on massage, acupunture, HA injections, mental therapy stupid ointments and gadgets that I thought would help me.

So yeah, 3 years into this and nothing done to help me. I've been to a spine surgeon, they seem to be gaslighting me. I'm pretty sure that the place that wants to give me spinal surgery wants me to get them before surgery, they are implying it, but have never verbally told me to get them so I'm just stuck in some kind of limbo forever.

 

[maryanne77]

I am so sorry. I just know way too many people that now have arachnoiditus from spinal injections. Try looking into peptides. Tb500 and BPC-157. There is an online site called Exploring peptides you learn more There or YouTube videos . These peptides help with back pain.

I think pre surgery they do these injections to see exactly where the pain is so that can help with a surgery. If you are not having a surgery I would not risk injections just for pain relief.

 

[rplate81]

I am so sorry. I just know way too many people that now have arachnoiditus from spinal injections. Try looking into peptides. Tb500 and BPC-157. There is an online site called Exploring peptides you learn more There or YouTube videos . These peptides help with back pain.

I think pre surgery they do these injections to see exactly where the pain is so that can help with a surgery. If you are not having a surgery I would not risk injections just for pain relief.

I have been taking collagen since I had that injury because it is supposed to help maintain cartilage. It has helped a lot with my hair, not sure if anything else though.

I know of the prerequisites that are usually needed before a surgery, although I have seen a person get surgery like right after they get an X-ray or MRI without doing anything. That's not something that I would ever want to do though unless it was a life or death thing.

I have been skateboarding most of my life with a few break periods here and there, but I have been jumping down huge tall stairs and handrails, all kinds of obstacles so I've had a TON of injuries skateboarding, I can't remember how many broken bones, stitches, knocked out teeth, broken ribs, KO's, etc. I would compare how I have been skating so aggressively for years no different that full contact football, but with no helmet and pads. It's brutal but I'd like to say that I have no regrets because I am in love with skateboarding and I have given skateboarding my body and my mind now fully since most of my issues/pain are from skateboarding, although I was in a bad car wreck about 4 years ago. I never went to the ER because I felt ok, but I have a feeling the accident is now catching up to me.

It's super annoying to have chronic ongoing pain especially nerve/sciatica stuff, but I'd never rush into a surgery for an orthopedic problem or anything like that unless it's an emergency. But yeah, the nerve stuff/sciatica really fucks with your head, especially mine because I have always been athletic, if I don't get fairly physical exercise daily, my mental health really suffers. I don't think that I'd be taking all this so hard if I was leading a sedentary life, but going from 3 or so hours a day intense sport exercise to having zero confidence in participating just hits me hard. I still remain as active as I can, but it's getting harder to just get the motivation to get out of my house now that my body is talking to me 24/7.

 

[rplate81]

I can heavily relate. Way too many injuries to name and now really feeling it.

Ive been looking into SubQ injections of wither BPC-157 and/or TB-500, leaning more towards BPC157 due to the much more clinical data on it.

Any additional updates from anyone would be appreciated!

So do you buy the BPC/TB and shoot it yourself?? I see that is not approved by the FDA and it stands as a research chemical.

 

[maryanne77]

So do you buy the BPC/TB and shoot it yourself?? I see that is not approved by the FDA and it stands as a research chemical.

There are peptide places that sell them . They are definitely unapproved for human consumption and the companies can only sell for research purposes. However many people in the chronic pain community and the bodybuilding communities swear they help with pain and healing. There are risks and you to do research on buying from a reputable place . The biggest down side is they are expensive. SubQ injections work a bit better than oral or nasal . Insulin is a peptide so is that weightloss drug all the stars are taking I think its called Ozempic but bodybuilders and biohackers have been using it years before big pharma got a hold of it.

 

[rplate81]

There are peptide places that sell them . They are definitely unapproved for human consumption and the companies can only sell for research purposes. However many people in the chronic pain community and the bodybuilding communities swear they help with pain and healing. There are risks and you to do research on buying from a reputable place . The biggest down side is they are expensive. SubQ injections work a bit better than oral or nasal . Insulin is a peptide so is that weightloss drug all the stars are taking I think its called Ozempic but bodybuilders and biohackers have been using it years before big pharma got a hold of it.

Ah ok. I'm not going to look into them. I had a bad experience once with an RC that has forever made me scared to try any again.

 

[CfZrx]

So many great posts here on bupe. My viewpoint is that 6 mgX 2 daily buccal is ideal.
------------> I do 2mg in the morning, 2mg at noon, 2mg at 2pm, and finally 6mg at 4pm <---------------
To be honest though, it has had analgesia at every dose I have tried! A for euphoria, I find it increases in a dose-dependent manner up to 12 mg and anything beyond that has felt just like 12 mg.
But the studies on pain led to those 0.3mg temgesic tablets, so that makes a guy wonder....
oh, p.s. I think my use of cannabis potentiates the bupe A LOT. Or maybe the bupe potentiates the THC, lol not sure

 

[CfZrx]

Before my back and legs got fucked from from sciatica, I got Hylarounic Acid injections in both knees about 2 years ago. $1500. They seemed to help for a week or so. I refuse to get cortisone steroid injections though. Those were the first and only thing the doctors and pain clinic were pushing on me.

Hi rplate81,
In my experience you need to b referred to a surgeon. If the surgeon decides you are not a candidate for surgery, they will refer you to pain management. In order to end up on opioid pain meds, you must allow the pain docter to inject you wit steroids that for me did nothing.
Please understand that they need to do these injections due to getting fat reimbursement checks from your insurance. After the injections fail,, THEN you will be prescribed pain meds.
My insurance, despite my record as a substance abuser wanted the pain doc to prescribe me fentanyl patches.
After a DNA cheek-swab, it was decided that methadone would have the slowest metabolism (so stronger effect). The doc was right, methadone was like a wonder drug! During the great dumping of all clients on pain meds to suboxone, I too was forced onto sub.
Sub WORKED JUST AS WELL AS METHADONE!!
So these then are the mandatory steps one must complete to end up on narcotic pain meds in my experience.
Thank fuck!
peace,
CfZrx

 

[rplate81]

Hi rplate81,
In my experience you need to b referred to a surgeon. If the surgeon decides you are not a candidate for surgery, they will refer you to pain management. In order to end up on opioid pain meds, you must allow the pain docter to inject you wit steroids that for me did nothing.
Please understand that they need to do these injections due to getting fat reimbursement checks from your insurance. After the injections fail,, THEN you will be prescribed pain meds.
My insurance, despite my record as a substance abuser wanted the pain doc to prescribe me fentanyl patches.
After a DNA cheek-swab, it was decided that methadone would have the slowest metabolism (so stronger effect). The doc was right, methadone was like a wonder drug! During the great dumping of all clients on pain meds to suboxone, I too was forced onto sub.
Sub WORKED JUST AS WELL AS METHADONE!!
So these then are the mandatory steps one must complete to end up on narcotic pain meds in my experience.
Thank fuck!
peace,
CfZrx

WOAH. So you are flagged as an addict, but you are getting Fent patches prescribed?? What country are you in?? Are you in hospice?? Sorry if my questions were offense, I am just curious and
I have seen a spine surgeon like 3x for about a year. Just consultations with two different PA's, not the surgeon. They just instilled fear in me by pestering me to get 2 different back surgeries, fusion and some surgery that requires hardware. Out of all of the doctors, specialists, surgeons, chiropractors, PT's that I have worked with over the last 3 years, only one PT asked me how I actually felt instead of looking at my MRI's and telling me I'm fucked like everyone else.

I think that I mentioned it, but I tried getting some Hylarounic Acid injections in my knees that cost me $1500.

After doing research and hearing friends tell me, I am really hesitant to get the steroid injections. Seems as if they last a month, sometimes less if they work at all.

I've never had luck with Buprenorphine working for pain. I think that Methadone worked ok, but that was a long time ago before I was having chronic pain issues.