Bupe: The Less Is More Myth Exposed

[boxcut3]

I'm so glad someone took the time to post this because while many people might have interpreted "less is more" as related to the ceiling effect, I have seen NUMEROUS posts which had people asserting quite strongly that anything above 8mg is absurd and completely unnecessary. Their "less is more" argument was quite literal in the sense that they truly believe and state as fact that taking less bupe will do more for a patient and that high doses will only make you sick. Of course this isn't true but I have seen so many people writing this to new BMT patients as though it were a fact. So while a few of the above posters might think it's funny and the original poster didn't understand what "less is more" really meant, I have to disagree and say that maybe those individuals haven't seen all of the posts that tout "less is more" in the literal sense.

 

[Desdenova]

Here's the way I always figured it worked:

I always figured they were seeing the effects of moving from an unecessarily high dose to the appropriate dose for their level of addiction.

Then people misinterpreted this as less being more effective, maybe because they were less 'foggy' like the email said, or feeling less of the negative side effects

But I don't have firsthand experience with Buprenorphine

 

[556m4]

This letter from R&B hits the nail right on the head. One thing I've learned through the years with opiods, especially bupe is people react differently depending on their body chemistry, metabolism, genetic factors, brain circuitry, personality, addiction level, etc.
However I think the protocols need to be reevaluated and the doctors should try to find the lowest possible dose that holds the paitent like maybee starting at like a 1mg dose and titrating upward 1 to 2mg a time. I've read paitent stories of people being prescribed 24mg of suboxone a day for 60-80mg of oxycodone a day, which seems a little absurd to me. Then again what the fuck do I know I'm not a doctor/chemist/scientist.

 

[Mr Blonde]

Good work on taking initiative on getting in contact with both of those sources, Tchort. :D

 

[pofacedhoe]

Good thread

It makes much more sense that being on a dose that's high enough to combat cravings and withdrawals, but low enough to maintain that clarity of mind and other such mental benefits, is where the "less is more" statement hails from.
Both Reckitt Benckiser and NAABT seem to agree in one way or another with this it appears.

this is yet another exaple of superstition, for instance, walking under ladders is bad luck (its not its just an easy way to lead to a possibly crippling accident for the walkee or the poor git 20 feet up), etc. there are loads of examples but i cant be arsed. oh yeah vampires dont like garlic (vampires dont exist but what do exist that drink your blood is a wide range of parasites that cannot tolerate garlic in the blood).

people fail to understand causality all the time, and try to explain logical statment with catch all mumbo jumbo, why should bupe be ANY different?

 

[djsim]

Everyone,. this is what OD should be like. Not these self-serving threads of late. Hold this as the bench mark for OD posting.

Great job TChort

Once I've the entire thread I'll chime in with my professional opinion

 

[Tchort]

I'm so glad someone took the time to post this because while many people might have interpreted "less is more" as related to the ceiling effect, I have seen NUMEROUS posts which had people asserting quite strongly that anything about 8mg is absurd and completely unnecessary. Their "less is more" argument was quite literal in the sense that they truly belief and state as fact that taking less bupe will do more for a patient and that high doses will only make you sick. Of course this isn't true but I have seen so many people writing this to new BMT patients as though it were a fact. So while a few of the above posters might think it's funny and the original poster didn't understand what "less is more" really meant, I have to disagree and say that maybe those individuals haven't seen all of the posts that tout "less is more" in the literal sense.

Exactly the point.

"less is more" is simply a slogan used by people on this board for some time now to spread false information relating to how Buprenorphine works. I don't mean it in a literal sense, or anything other than a label for the core ideas of bad advice and misinformation going around.

Yes, RB and NAABT advocate using the lowest dose that controls cravings and withdrawal symptoms. So? That wasn't the point. And I have never quarreled with this point. Latching onto this is pointless, it is not what this is about.

I don't believe I've misunderstood anything given the quotes from posters here in the original e-mail. Plus I explained what constitutes the theory that I debunked.

R-B and NAABT have acknowledged:

-Some patients do indeed need 8-32mg a day to control cravings and withdrawal symptoms.

-Some patients do not feel held or have their cravings controlled on any dose of Buprenorphine.

-The idea that no patient could need more than 8mg a day is a misunderstanding and misconception

and so on.

People seem to be changing their tune now about what they meant, or said. I would be happy to go over the megathread and other 'self-serving' Bupe threads as of late where incorrect information stemming from these false ideas of how Buprenorphine works is spread as fact to people with questions about going on or off Buprenorphine maintenance.

I don't hold anything against anyone for giving their opinions, or explaining their experiences with BMT to people with questions about it. But there is a big difference from that to transferring your experiences as scientific fact;

i.e. because you did not need 24mg a day, does not mean that no one needs 24mg, or 32mg, a day.

I am not advocating higher doses of Buprenorphine, I am advocating the facts. To make recommendations to people, that people often do take literally especially when more than one person gives the same advice, based on incorrect informations is highly irresponsible. Especially when harm-reduction is the goal. Relapse and continued use of narcotics is pretty widespread from self reports and reports from Bupe doctors- often because of how the BMT system is regulating and the lax policies surrounding its use in maintenance. People who try to stay abstinent may indeed need a dose increase instead of a dose reduction. When they take away from a site like this where they ask for advice that they need to lower their dose, they probably will: What happens to that person when the lower dose does no better or does worse for them than the original dose? Anyone want to take responsibility for giving bad advice when someone relapses or overdoses?

We don't know what happens to people who ask these questions unless they report back. Look how many people who posted here are dead in the BL shrine. We can't afford to pretend opinions are fact when people put trust, for right or wrong, in what we as a whole advise them.

 

[weside]

I have been on sub for 2 years and started off with 32mgs a day and then worked my way down to 8mgs a day and then i started to get anxiety at the end of the day so i started taking 8 in the morning and 8 at nite so i take 16mgs aday now and it seems to work the best for me.
So i think that it varies from person to person, if i take 4mgs it just gives me major anxiety and i will just crave all day, so the less is more for me dosen't work so well, but everyone is differnt. And for those that did powder dope, everytime you go cop i bet that you don't always get herion, my buddie/exdopeboy got his house radied and the cops found heroin but they also found a bunch of empty bags witha little dope in them and not one tested for heroin they where all chemicial dope or fent, or god knows what which makes me worry, what was i putting into my arm for ten years?

 

[Johnny blue]

^ the anxiety is pretty common I think. More and more doctors are combining bupe with a benzo such as ativan.

Tchort, 8mg is the most prescribed version, I'm not gonna argue with you there. The reason is IME that it is WAY cheaper than buying a comparable prescription of 2mg. You're saying that 32 is usually the highest dose, sure. Simple math tells me that could be the reason 8mg pills were made, no?

Maybe I'm missing something here but, I really don't get the harm in saying "less is more". If the victims of this seemingly unknown atrocity simply take more than what is the issue? I know what you mean as far as people saying everyone is on too much bupe, I just can't imagine someone not taking enough to be comfortable only because bluelighters said so.

 

[Tchort]

^ the anxiety is pretty common I think. More and more doctors are combining bupe with a benzo such as ativan.

Tchort, 8mg is the most prescribed version, I'm not gonna argue with you there. The reason is IME that it is WAY cheaper than buying a comparable prescription of 2mg. You're saying that 32 is usually the highest dose, sure. Simple math tells me that could be the reason 8mg pills were made, no?

Maybe I'm missing something here but, I really don't get the harm in saying "less is more". If the victims of this seemingly unknown atrocity simply take more than what is the issue? I know what you mean as far as people saying everyone is on too much bupe, I just can't imagine someone not taking enough to be comfortable only because bluelighters said so.

This goes back awhile on BL, but for awhile now several posters have been spreading misinformation to people with questions. I think this is wrong. "Less is more" is a kind of slogan several of them use when giving this misinformation: which is why I chose to call it as such in this post. In several of these threads people thank posters for this advice, despite its inaccuracy, and often write how they will do just that: lower than dose because it was recommended to them by a few people on BL.

If you don't follow many Bupe threads you wouldn't know about this. I'd really rather not go through old threads to put together more examples than the few on the original post, but I will if that will help people who haven't seen it understand why I felt the need to post this.

 

[Tchort]

From the Buprenorphine Mega Thread

you're dose is way too high. Suboxone is expensive and you're spending a lot of money you don't need too. I don't care how many bags you were shooting a day, 8mg a day is plenty. Most people don't feel a difference in dose at all past 8mg or 12mg. Meaning, 8mg feels the exact same as 24mg.

You could immediately go from 24mg a day to 8mg a day and not notice a difference. So you should do that now. Stay at 8mg for a week or two, then go down to 6mg. The next week, go down to 4mg. The difference between 4mg and 8mg a day is very little.

A lot of people (including me) have reported a phenomenon with Suboxone that taking less produces more effects (to a point, obviously). I feel better on 4mg than I would on 12mg.

There are a lot of doctors that don't quite know as much as they should about Suboxone. Too many doctors prescribe a daily dose higher than is truly needed. Mine started me out at 16mg as well.

I take 4mg a day right now, and usually take 2mg in the morning and 2mg later.

The thing you have to be aware of is your drug abuse mentality that tells you more is better. In this case, less is often more. Once you get down to the 2mg or 4mg a day range, taking double your dose should produce a decent buzz.

Also, 24 mgs is just too high. You don't need more than 8 mg in most cases. 8mg has been fine for me even when my habit was up to over 1.5g/day.

I agree with kc, 24 could be too high of a dose. I've had similar feelings from dosing too high. Sixpartseven sums it up at the beginning by stressing that with bupe less is more. Just because you're not 100 percent doesn't mean take more. Also I believe the drug peaks at around 100 minutes so keep that in mind before you over do it and feel like shit again.

From the post originally quoted, swapping buprenorphine to methadone:

have you tried lower doses of bupe man? most ppl do not need to be on doses of bupe that high and most of the time, the lower the dose, the better with bupe. its very rare that a person NEEDS more than 8mg honestly. i get more from doing 2-4mg than i ever would from say 16mg or even more. you might wanna try that before switching to methadone.

yes i know it doesn't seem like much but LESS IS MORE with buprenorphine. you should read the suboxone mega thread sometime. ppl in there post all the time about how they feel more and get more craving relief from smaller doses. doctors overprescribe bupe all the time. i'm prescribed 24mg/day but only take 2mg a day b/c i don't need that much, and i came off a half gram a day heroin habit, not a small habit by any chance.
what was your DOC and how much were you doing? cause unless you were doing massive amounts of something, there's no way you NEED that much bupe. i guarantee you will get the same relief, if not better relief from doing a little less. unless of course you psych yourself out by thinking its like most other drugs where you do more, you get more effects.
buprenorphine is a partial agonist and it also has antagonistic effects, which is why it has a ceiling dose.

I think that mental state has a lot more to do with it than differences in body chemistry. If someone goes into buprenorphine maintenance thinking that more is ALWAYS better, then there is no chance that anything else will work.

While I do agree that 2mg is a little low for some people, 24mg is just outrageous. For the first month or so, I was on 16mg, and would have never imagined that just 8mg is just as good (or better), but that is the case.

Anything over 8mg is unnecessary. 2mg held me, but 4mg is where I feel comfortable.

People who can't manage with 8mg or less are still caught up in that drug-using/pill popping mentality where you are constantly looking for your next fix and always want more. They also were probably looking for effects like those of full-mu agonists, and find anything less to be unacceptable.

I agree with chrisinabox; smaller doses of buprenorphine give you more than larger ones.

anything above 8mg a day is ludicrous. I came off just as big of a heroin habit as most people here (though I know others on this site were using more than me), and I never needed more than 6mg the first few days of coming down, and I never needed more than 4mg past that.

There are people on this board who used to mainline 2 grams or more of heroin each day. Can you tell me why they aren't taking 32, 24, 16, or 8mg at a time, and why they also think they can get something out of 2 and 4mg doses?

It's because they let their tolerances drop when they quit heroin, and they kept working it down with buprenorphine.

If you take 32mg of suboxone each day, you're likely to keep your tolerance as high as it could possibly get. That means, if you need to use mu-agonists in the future, your tolerance to them will be just as high as when you quit (if not much higher). Most people don't actually get their tolerances down on buprenorphine, but actually work them higher than they were before.

32mg of buprenorphine would last me over 2 weeks. And it doesn't last you more than 24 hours?

The self-fulfilling prophecy.

Yes, if you think you're going to need 32mg of buprenorphine a day, then no, you won't feel good from 2mg or 4mg doses because you won't let yourself.

Examples of the problem.

 

[Johnny blue]

If there are people that need to stay on maintenance indefinitely or for an extended period than there's no value in lowering dosage. If they have the means to follow a schedule than they should, ok I agree with you there.

Sometimes and quite often when people say "I can't afford it" or "I want off" I think it fits well.

 

[Johnny blue]

In the future if you're going to quote me you can leave my name. If you can tell me how saying 24mg COULD be too much is wrong I'd love to hear it.

Apparently you aren't reading many replies in this thread. I said I follow bupe threads. If you want to site examples where are any of posters saying the advice failed?

 

[GlassAss420]

"This letter from R&B hits the nail right on the head. One thing I've learned through the years with opiods, especially bupe is people react differently depending on their body chemistry, metabolism, genetic factors, brain circuitry, personality, addiction level, etc.
However I think the protocols need to be reevaluated and the doctors should try to find the lowest possible dose that holds the paitent like maybee starting at like a 1mg dose and titrating upward 1 to 2mg a time. I've read paitent stories of people being prescribed 24mg of suboxone a day for 60-80mg of oxycodone a day, which seems a little absurd to me. Then again what the fuck do I know I'm not a doctor/chemist/scientist. This letter from R&B hits the nail right on the head. One thing I've learned through the years with opiods, especially bupe is people react differently depending on their body chemistry, metabolism, genetic factors, brain circuitry, personality, addiction level, etc.
However I think the protocols need to be reevaluated and the doctors should try to find the lowest possible dose that holds the paitent like maybee starting at like a 1mg dose and titrating upward 1 to 2mg a time. I've read paitent stories of people being prescribed 24mg of suboxone a day for 60-80mg of oxycodone a day, which seems a little absurd to me. Then again what the fuck do I know I'm not a doctor/chemist/scientist. "

Naw they should just start at 8mg a day, then down to 4 mg when the patient decides, 2 mg, then 1, 0.5? then off. Really 1mg is not enougth to start with. If they need 16 or 24 mg then they should come back and ask for it. 4-8 mg has always been enougth for me, only a few times off the biggest binges did I use 12-16 mg of subs, and I felt pretty good from 16mg, not high but hardly a hint of sickness, coming off like 15-20 blows a day for weeks..

 

[Spaazkaz]

so lemme get this straight... less can be more, more is probably more, but more is never less. -Spaz-

great thread by the way, very cool of you to take the time to email them. I am astonished you got someone to write you back at all, let alone someone who knows what they are talking about!

 

[Johnny blue]

To clarify, less is more is a figure of speech. Literally less can't be more of course. I'm not sure if that's the message here but I think that's what Tchort is saying.

The point is often people can get by just fine on less than they are prescribed or even think they need.

 

[chrisinabox]

Exactly the point.

"less is more" is simply a slogan used by people on this board for some time now to spread false information relating to how Buprenorphine works. I don't mean it in a literal sense, or anything other than a label for the core ideas of bad advice and misinformation going around.

Yes, RB and NAABT advocate using the lowest dose that controls cravings and withdrawal symptoms. So? That wasn't the point. And I have never quarreled with this point. Latching onto this is pointless, it is not what this is about.

I don't believe I've misunderstood anything given the quotes from posters here in the original e-mail. Plus I explained what constitutes the theory that I debunked.

R-B and NAABT have acknowledged:

-Some patients do indeed need 8-32mg a day to control cravings and withdrawal symptoms.

-Some patients do not feel held or have their cravings controlled on any dose of Buprenorphine.

-The idea that no patient could need more than 8mg a day is a misunderstanding and misconception

and so on.

People seem to be changing their tune now about what they meant, or said. I would be happy to go over the megathread and other 'self-serving' Bupe threads as of late where incorrect information stemming from these false ideas of how Buprenorphine works is spread as fact to people with questions about going on or off Buprenorphine maintenance.

I don't hold anything against anyone for giving their opinions, or explaining their experiences with BMT to people with questions about it. But there is a big difference from that to transferring your experiences as scientific fact;

i.e. because you did not need 24mg a day, does not mean that no one needs 24mg, or 32mg, a day.

I am not advocating higher doses of Buprenorphine, I am advocating the facts. To make recommendations to people, that people often do take literally especially when more than one person gives the same advice, based on incorrect informations is highly irresponsible. Especially when harm-reduction is the goal. Relapse and continued use of narcotics is pretty widespread from self reports and reports from Bupe doctors- often because of how the BMT system is regulating and the lax policies surrounding its use in maintenance. People who try to stay abstinent may indeed need a dose increase instead of a dose reduction. When they take away from a site like this where they ask for advice that they need to lower their dose, they probably will: What happens to that person when the lower dose does no better or does worse for them than the original dose? Anyone want to take responsibility for giving bad advice when someone relapses or overdoses?
We don't know what happens to people who ask these questions unless they report back. Look how many people who posted here are dead in the BL shrine. We can't afford to pretend opinions are fact when people put trust, for right or wrong, in what we as a whole advise them.

what happens? they take more suboxone until they get the relief they need! and if the lower dose doesn't help like the dose they were already on, then they try something else, which they would have done anyways. all we are saying is that maybe they should try everything with bupe before giving up and trying something else. i've seen many posts about ppl that just got on bupe and don't like it at all, and its not giving them any relief, so we mention that maybe they should try to take a little less before giving up and going to another drug, and when they do this, they start getting some results that they were looking for. "subisjustokay" is one person that said this, for example.


tchort, i still haven't seen your response to mine and johnnyblue's question about how we are hurting anyone by mentioning to ppl that taking less sometimes works better. if they try it and it doesn't work, ok then they go back to where they were or try something else, which they would have done anyways.
i seem to notice that you keep using my posts as examples of ppl spreading this "less is more" thing as "fact". i failt to see this, all i see are ppl giving their opinions that worked for them and many other ppl, yes they might feel strongly about their opinion but i've yet to see anyone try to put this off as "fact".

 

[Johnny blue]

^ exactly my point. In fact I see more harm in telling someone to take more than they may need. You can always take more if it doesn't work. You can never take less if its too much for ya.

 

[Captain.Heroin]

People like the effects of norbuprenorphine better, so they dose lower and get more of an agonist effect out of their medication.

This is why "less is more"; less active ingredient delivers more pleasant effects than a higher dose. This is why taking 8mg (or more) at a time is less effective...for people with LOWER opiate tolerances.

If you have a super super high opiate tolerance from all those years of IVing heroin (lol naughty you ), then maybe you do need more than 8mg a day, possibly 16mg. But at this point, you're going to have to work a long way down the buprenorphine ladder (which won't seem like too much of a hassle to someone who was facing to cold turkey a large heroin habit).

If you're someone who feels it is absolutely necessary to take 16mg a day, I suggest working on your taper schedule so that you get down below 8mg a day. See if that's effective enough for you; if it isn't, then you were right, you need 16mg.

If you find better results with a dose below 8mg a day, then start shooting for that.

 

[smackem]

Suboxone talk zone doctor agrees with us,


nubain is similair, in that there is more MU activation at smaller doses.
Lemmie find suboxone talk zones docs post...
*and this doc has MAD cred.*


http://suboxforum.com/viewtopic.php?t=123


There are more reasons for limiting the dose; there is way to much diversion going on that threatens to cause greater regulation and reduced access to buprenorphine. Plus, when you take very high doses of bupe you start to get an antagonist effect that results in LOWER opiate effects.



Since nalbuphine and other partial agonists/antagonists act in the same manner, I know someone out there knows the answer. That person is probaly sitting around right now going 'shut up idiots, i gave you more bupe than you could ever use, dont ruin it!'. I think it is related to the metabolites of bupe, namely norbupe. The scientific/medical community isn't ignorant to the situatation, WE just havn't found the answer yet...