Bupe Told My Bupe Doc That the Bupe Dosages Commonly Scripted are Unnecessarily High

[Chainer]

I guess I can relate. I figured out how SSRI/SNRI companies market to doctors a while back and it has bothered me since... but a hospital is ultimately a business in the US. My doctors have never cared to hear my side of the story, but they are understanding about enough other things to make up for that blunder.

 

[shoolameet]

Daddysgone- I agree with you on all points. I've gone from the obligatory 16mg dose down to 4mg daily and I am "held" just as well as I was on 16mg. However, I have noticed that I'm having cravings I didn't have before and have taken advantage of the fact that you can indeed breakthrough a dose as low as 2-4 mg. To be honest, I wish I had the money (my ins. does not cover bupe) to stay on a higher dose so I won't be tempted to cheat and those cravings could be kept at bay. Other than that, you're spot on.

BTW: Been on bupe for 18 months now.

I agree with what you said about cravings. I am currently on 14mg a day, and while I know 8mg would "hold" me just as well, I find that I crave less on my current dose.

 

[funkee]

I'm one of those patients on the upper end of the spectrum. My doctor happens to have experience with buprenorphine from the early 90's having started treatment underground. Not too far alongs the feds got involved and so did he and his partner and fought many legal battles with the FDA until it was approved in the United States and was enlisted to write the certification exam. He's well informed about the mechanism of buprenorphine and that perhaps 16mg instead of 32 for my 1,000mg/oc/day habit would've covered my symptoms just fine. But the goal with maintenance is not to have you on as little as possible. It's to cover the symptoms and have the patient on steady dose to allow the heavily damaged mu receptors to heal. Rapid/Ultra-Rapid detox is a different story. We're talking about maintenance here. The dependency on buprenorphine goes beyond the scope of mu agonism, which is the cause of many psychological symptoms people report. Because of the highly protein bound nature of buprenorphine (96% bound to plasma), a higher dose will reduce the fluctuations from high to low, which impede healing and recovery. A person who takes 2mg once a day, which covers their symptoms but leaves them waking up with even the mildest symptoms, defeats the purpose of bupe maintenance. You might as well be on methadone for life. Keeping a constant dose, no highs and no lows, means going beyond the immediate efficacy of the drug. When it's taken at first, most of the drug is unbound and active, but within a few hours whatever hasn't been metabolized joins a protein-drug matrix and is released over a period of time. A higher dose than what is ground zero for most people is necessary also because of the locally synthesized antagonist action of beta-arrestin. Beta-arrestin(2) is thought to desenstize receptors, created by a sudden in increase of burpenorphine, causing a semi-permanent rise in tolerance. I don't plan on my taper being a quick one, but if it's done properly with no symptoms I should be able to get down from 32 to 0.25 within ~2 years. 5 years should be a good aim for most people on maintenance. However the psychological effects of the withdrawal at such high/long doses are just started to show their faces. I don't expect my experience to be a pleasant one, but precipitating withdrawals accidentally from a 1g oxy/day habit wasn't pleasant either.

 

[qwe]

It was recently discovered to have been produced in users who increase the dosage of burpenorphine too rapidly, causing a semi-permanent rise in tolerance.

can you explain this part?

i'm on 24mg a day... i will try this thread's hypothesis that lower doses could work just as well

weird to know that i'm not hitting my mu receptors with anything... it makes sense, bupe is a very weird drug, very different psychologically

 

[funkee]

can you explain this part?

i'm on 24mg a day... i will try this thread's hypothesis that lower doses could work just as well

weird to know that i'm not hitting my mu receptors with anything... it makes sense, bupe is a very weird drug, very different psychologically

Wow, I didn't realize my grammar was that bad. I edited it a little.

I don't know an awful much about it, taken from the wiki page of the gene:

Members of arrestin/beta-arrestin protein family are thought to participate in agonist-mediated desensitization of G protein-coupled receptors and cause specific dampening of cellular responses to stimuli such as hormones, neurotransmitters, or sensory signals,[1][2][3] as well as having signalling roles in their own right.[4][5][6][7][8] Arrestin beta 2, like arrestin beta 1, was shown to inhibit beta-adrenergic receptor function in vitro. It is expressed at high levels in the central nervous system and may play a role in the regulation of synaptic receptors.

Most of this is beyond my comprehension of pharmacology, perhaps someone else could shed more light on it.

Regarding your second point, buprenorphine does agonize the mu-receptor. It is known as a partial-agonist, and does permit some healing to take place and lowering of tolerance. A full agonist like methadone (long acting) or oxycodone (short acting) can only increase your tolerance. Persons who aren't dependent on opiates will get a euphoric effect from bupe just as if they consumed a full agonist. However, addicts generally don't get much except for the reduction of symptoms.

Regarding your dose, how long have you been on 24/day? I would be very cautious about reducing your dosage, and make sure you keep your doctor informed of your decision. By decreasing your dose too fast, you will hurt your recovery by inducing withdrawal symptoms. The idea behind tapering or reducing one's dosage is not to experience any symptoms. You'll have to figure out the right amount and time span to do so effectively. In my experience anything more than 10% every 4 weeks will cause withdrawal symptoms. If you find the dose is insufficient, you'll have to increase the dose just as carefully, so as not to increase your tolerance. Being at 24mg/day is a tough spot. 32 is even harder. It's right around the ceiling dose, +/- for absorption and individual differences. I know of some individuals prescribed 40mg/day, which appears to be above the 32/day ceiling, however beyond tolerance and absorption there appear to be other intricacies.

 

[Johnny blue]

I've tried to read this thread. About page 3 I forgot what it was even about. People maintaining 73k dollar a year H habits. People shooting their bupe scripts. Seems like a classic OD bupe thread to me

Anyway Daddysgone, any updates on your treatment? Has your dose been lowered? Has your doc even brought it up since?

 

[poppyplanet]

I'm glad someone finally spoke up and stuck up for us clients instead of spoon feeding off the pharmaceutical bs. They definetly over-prescribe bupe. It's all about money, and the sad thing is, most doctors soley go on what their group medical meetings tell them instead of listening to the people that matter-us, patients.

 

[low-dosejunky]

Just wanted to say that sure, not all doctors are "in it for the money" but I think you're being more than a little naive if you think there's no way for them to be compensated for making R-B a LOT of money by over-prescribing. When you walk into a doctors office and you see "seroquel" calenders, and "prozac" pens, "subutex" clipboards with "avodart" paper - who do you think paid for all that? Not the doctor that is for certain. ;D

How much money do you think a single office saves in a year when they don't buy a single calendar, clock, stationary, tongue depresser, etc. It's not a coincidence they're everywhere in a doctor's office. Look around next time you're there - how much of this crap lying around their office is an indication of how many pharmaceutical sales representitives have been by the office, and how many your doctor actually cared to listen to. If the product's name is there, he took the bait.

However, these are the *minor* incentives. They also have get-togethers where they push their products, and of course the doctors are allowed to bring their wives and whatnot to the local country club, or on a cruise, or this or that. They may even pay for a private vacation for you.

Don't take my word for it, there's been many exposes' written or televised on our corrupt pharmaceutical industry. Many doctors have spoken out about the sorts of things they were offered to prescribe their medicines over the competition, or over the necessary amounts. Several of these doctors claimed actual cash kickbacks when they got a patient on a medication they would be forced to take for the rest of their life, but I'm not sure I buy that much into it.

This is why we're getting insurance instead of real healthcare, like the europeans and canadians get. The cash. Sorry to burst anyone's bubble.

 

[stuckinaloop]

lol honestly I don't think doctor's offices save THAT much money getting some free pens and pads. shit costs fucking barely anything to begin with

 

[lozgod]

Back to the topic. Earlier I stated a low dose could hold me despite my high tolerance. Well that is no longer true at this stage in the game. My pattern is do all of my roxis in 3-4 days, then my methadone lasts me 2 weeks (prescribed) then I buy 10 suboxones to hold me the other two weeks and it is always hell switching over from methadone to suboxone, but this time 4mgs knocked me in to PW and now it takes 16mgs to ward off WD symptoms.

Guess the low dose statement is relative and not all inclusive.

 

[stuckinaloop]

Back to the topic. Earlier I stated a low dose could hold me despite my high tolerance. Well that is no longer true at this stage in the game. My pattern is do all of my roxis in 3-4 days, then my methadone lasts me 2 weeks (prescribed) then I buy 10 suboxones to hold me the other two weeks and it is always hell switching over from methadone to suboxone, but this time 4mgs knocked me in to PW and now it takes 16mgs to ward off WD symptoms.

Guess the low dose statement is relative and not all inclusive.

I think you could get by with the same amount of suboxone, maybe a little more is needed but I think the real factor was that you switched over too early.

I am not sure how long you waited from your last dose of methadone to dose the bupe, but if it wasn't atleast 3 day's you switched too early which is the bigger part of the reason why 4mg didn't seem to help you.

 

[qwe]

so far 4-8mg a day is no different than 24. been 4d

so there's absolutely no point at all in going above eight if i'm seeking a nice feeling?

if i'm on 2mg a day, how much vicodin would be required to break through to get an equivalent feeling of a normal 40mg dose without the block?

 

[Pegasus]

^You should know that the ceiling dose of bupe is around 16mg, maybe a bit higher for some...

As for the second part, you'll just have to experiment a bit. 2mg isn't going to block your receptors entirely almost certainly, so keep that in mind...

 

[qwe]

the literature here says 32mg but ive heard 16mg once on bluelight.

 

[lozgod]

I think you could get by with the same amount of suboxone, maybe a little more is needed but I think the real factor was that you switched over too early.

I am not sure how long you waited from your last dose of methadone to dose the bupe, but if it wasn't atleast 3 day's you switched too early which is the bigger part of the reason why 4mg didn't seem to help you.

I waited 5 days. I wouldn't get sick no longer how I waited. Figured I'd take a chance. Regretted but am doing good now. I am now down to 8mg. Tomorrow I am shooting for 6mgs.

 

[daddysgone]

Back to the topic. Earlier I stated a low dose could hold me despite my high tolerance. Well that is no longer true at this stage in the game. My pattern is do all of my roxis in 3-4 days, then my methadone lasts me 2 weeks (prescribed) then I buy 10 suboxones to hold me the other two weeks and it is always hell switching over from methadone to suboxone, but this time 4mgs knocked me in to PW and now it takes 16mgs to ward off WD symptoms.

Guess the low dose statement is relative and not all inclusive.

Im nearly certain that the problems you are experiencing with suboxone are due to the fact that you keep jumping back and forth between full agonists and a partial agonist (bupe). It takes your body some getting used to when switching to a partial agonist. However since you keep jumping back and forth, Im not surprised that suboxone has not consistently "held you" at a particular dose.

For about a year I jumped back and forth between pods and bupe, and I know that I didn't really feel "right" until I completely switched over to bupe and began my consistent bupe maintenance.

Remember, its not like bouncing back and forth between something like oxy and dope (which are both full agonists). Your body can absolutely tell the difference between full agonists and partial agonists, so it is not surprising that you experience some discomfort and unpredictable reactions.-DG

 

[low-dosejunky]

If you think the pens and stationary, etc, are what I was really getting at you're missing the point. The point is that pharmaceutical sales representitives have already been to this office, in droves, and suffice it to say there's more than one way for a quid pro quo relationship to work. Or, as they say in particular parts of the country, "there's more than one way to skin a cat."

Like I said, look it up yourself. Anything from vacations, cruises, memberships at 'prestigious' country clubs, and cold hard cash of course.

Don't be naive and only look at the surface, understand how business relationships work behind the scenes.

 

[SZodiac]

so far 4-8mg a day is no different than 24. been 4d

so there's absolutely no point at all in going above eight if i'm seeking a nice feeling?

if i'm on 2mg a day, how much vicodin would be required to break through to get an equivalent feeling of a normal 40mg dose without the block?

That's been my experiance also. More doesn't do much as far as I can see. I think 4-8mg is all anyone needs once you've leveled out. Initially one might take more but after a few days you might as well cut back. They do provide a slight well being but very little high and for me, I still crave quite a bit.

Bollweevil is correct though that 2-4mgs doesn't block as well as say 8mgs does. It depends on the opiate though. Not sure about vic's, but Dilaudids seem to block quite a bit, Oxycontin's not as much but some and Heroin will cut right through 2mgs if you wait just 18-24hrs.

 

[opiatekrzy]

suboxone is VERY expensive med. it is around [snip] dollars at the pharmacy without insurnace, my theory is docs give u 3-4 subs a day to take to help pharmaceutial companies, it keeps the ball rolling. im on 3 subs a day, but only pay [snip] co pay for 90 pills month supply. in all reality, a heavy heroin addict only needs 8mgs at the most to be withdrawl free...4mg of sub kills all my w/d's whatever opiate im detoxing from... its funny in my area people pay [snip] per pill off the street, which is against the rules of this site and the doctor agreement but hey [snip] for 90 pills on a copay andmake [snip] off 10 pills cant beat it..oops did i say that

 

[oneswtwld]

I di the same thing the OP did and my doc was a COMPLETE ASSHOLE....

she would walk out of the room in the MIDDLE OF A QUESIOTN

she wouldnt even answer my questions.

I do not think she really cares whatsoever about the people she has on suboxone treatment... and she is the only of THREE in the entire county!!!! if not larger area....


i am ery disappointed in her and actually plan on giving her a piece of my mind next week...

sinc eI have been off subs for a few weeks now, i am going to go back and "re-up" and give her a what-for