Bupe or not to Bupe....

[FatBellyWhipSlay]

5....that is the question that I am currently mulling over in my head.

I am struggling with precription opiate addiction, Codeine, Tramadol and DHC.

I keep quitting and relapsing, time and time again. Everytime I relapse my consumption intensifies.

Currently I am on 600mg codeine phosphate a day, 120mg DHC and 200mg Tramadol, its a never ending cycle.

I have tried it all, Cold Turkey, Taper, 12 step program, CBT. The only thing I havent tried is Buprenorphine or a 28 days rehab detox.

I have been going to a drug clinic the past few weeks and they have put a few options down.

1st was them to contact my GP and issues me a script for Codeine phosphate alone so I can taper down from 600mg a day slowly over a couple of months. My GP would not do that, refused immediately,(would mean 20 tabs a day to start, reducing by 10% every week)

2nd Was for me to go cold turkey and they would prescribe Diazepam 10mg x 2 daily and Zopiclone 7.5mg a night for 14 days only, that wouldn't work for me as I know I would relapse, tried that before.

3rd option is for me to start Bupe, 2mg a day for a month only and then reduce slowly to none (this has already been sorted, they sent a script to my local pharmacy who range me this morning and said they have it and its ready to start on Friday).

4th option (if bupe fails) is they would put me in an NHS Detox rehab centre for 14days.

So with that in mind I am thinking about the bupe option (which would start friday so I would need to take a last does tonight so i dont go through PWD)

I know everyones different but I really dont know what to do... the bupe option is scaring me a little after everything i have read

I need ot get this sorted asap as I am on my last legs with my family and missus and dont want to lose everything.

That goddamn double widsom tooth extraction 7 years ago started this 7 years ago, if id know that now I wouldnt have started taking them... if i could turn back time (humming cher for some reason now)...

Thanks!

 

[THECATINTHEHAT]

The first thing I would advise is to separate the idea of recovery from the idea of detox in your mind. This should be easy for you to do as you keep relapsing so I'm sure you understand that getting clean and staying clean are two very different things. I follow exactly the same pattern in my using. That said, you need to be thinking about making two plans, one for detox and one for recovery.

In relation to the bupe, I think it sounds like a fairly good option. The number of people who can get clean or taper without medical supervision is pretty limited IMO and you sound like you've been through the mill a few times and that engaging with a controlled taper on bupe could be beneficial for you. You should be able to taper down to a very small amount fairly quickly if they start you on 2mg and then the detox at the end of that should be fairly 'easy', I jumped off bupe at 24mg with the help of some (a lot) of non-opiate meds and it was bearable (for me). I know it's scary engaging with something like that (partially because it means admitting to some degree that things are bad enough to require that) and of course there are down-sides, but if you can't stop relapsing and can't get through a detox then most likely things will only get worse until you accept some sort of outside help and a taper script on bupe could definitely help you stabilise and prepare for an easier detox at a later date, and more importantly help you start preparing for the second plan you need.....

How are you going to stay clean when you get clean? What changes are you going to make in your thinking/routines/behaviour/environment that is going to stop you from using again? This plan is much harder and will be very personal to you. To find a successful one you're going to have to be able to understand your motivations for using, what you get out of it and why you keep going back. Most likely the answer is that you have some form of emotional disturbance. Of course this idea is a cliche and it doesn't always hold true, but I think if you look at people who engage in really destructive and risk-taking addictive behaviour then it almost always is. I kind of always believed I was basically OK, like I had this idea that maybe I was a bit off-key but basically I couldn't identify any serious issues I had. Having got a decent bit of opiate/benzo/crack free time behind me (but also still had some wobbles along the way) and made a lot of changes in my life I'm now aware that yes I have some extremely deeply rooted issues that have contributed towards my using and I'm now working to undo those things. This plan is the important one.

You do actually have another option in that if you want to pay to go private you'll be able to find a doctor to prescribe you a codeine taper no problem. I was considering switching to a private morphine prescription at one point and it took less than 24 hours to find and arrange a meeting with a doctor prepared to do that (after consultation of course).

I hope that answers some of your questions or helps you feel a bit easier about the decisions you have coming up.

 

[FatBellyWhipSlay]

The first thing I would advise is to separate the idea of recovery from the idea of detox in your mind. This should be easy for you to do as you keep relapsing so I'm sure you understand that getting clean and staying clean are two very different things. I follow exactly the same pattern in my using. That said, you need to be thinking about making two plans, one for detox and one for recovery.

In relation to the bupe, I think it sounds like a fairly good option. The number of people who can get clean or taper without medical supervision is pretty limited IMO and you sound like you've been through the mill a few times and that engaging with a controlled taper on bupe could be beneficial for you. You should be able to taper down to a very small amount fairly quickly if they start you on 2mg and then the detox at the end of that should be fairly 'easy', I jumped off bupe at 24mg with the help of some (a lot) of non-opiate meds and it was bearable (for me). I know it's scary engaging with something like that (partially because it means admitting to some degree that things are bad enough to require that) and of course there are down-sides, but if you can't stop relapsing and can't get through a detox then most likely things will only get worse until you accept some sort of outside help and a taper script on bupe could definitely help you stabilise and prepare for an easier detox at a later date, and more importantly help you start preparing for the second plan you need.....

How are you going to stay clean when you get clean? What changes are you going to make in your thinking/routines/behaviour/environment that is going to stop you from using again? This plan is much harder and will be very personal to you. To find a successful one you're going to have to be able to understand your motivations for using, what you get out of it and why you keep going back. Most likely the answer is that you have some form of emotional disturbance. Of course this idea is a cliche and it doesn't always hold true, but I think if you look at people who engage in really destructive and risk-taking addictive behaviour then it almost always is. I kind of always believed I was basically OK, like I had this idea that maybe I was a bit off-key but basically I couldn't identify any serious issues I had. Having got a decent bit of opiate/benzo/crack free time behind me (but also still had some wobbles along the way) and made a lot of changes in my life I'm now aware that yes I have some extremely deeply rooted issues that have contributed towards my using and I'm now working to undo those things. This plan is the important one.

You do actually have another option in that if you want to pay to go private you'll be able to find a doctor to prescribe you a codeine taper no problem. I was considering switching to a private morphine prescription at one point and it took less than 24 hours to find and arrange a meeting with a doctor prepared to do that (after consultation of course).

I hope that answers some of your questions or helps you feel a bit easier about the decisions you have coming up.

thank you for your response, it was really helpful

I suppose "once i;m clean" i need to look at why i keep using in the first place and combat that. i was a big drug user since 14 (now 46) and i suppose ive always felt the need to take something to enjoy the normal things in life. my childhood was relatively ok with a bit of emotional abuse from my step father (who would always put me and my brother down at all times which results in me having a really bad stammer). But I think what would help me the most is realising somehow that I dont need to take drugs to enjoy life....

I tried the private option but they wanted £1000 a month which I cant afford. Private rehab was £10K which is even more out of my league!

I just read a lot about how people keep saying "you shouldnt be on bupe for Codeine, Tramadol and DHC, its like putting you on heroin (as its a lot stronger than the said short-acting opiates) but the doc worked out some maths shit and said I should be on 2mg)

so that is what im worried about the most, making a mountain out of a molehill...

 

[THECATINTHEHAT]

Yes that is a legitimate concern and you are right to think carefully before making that move. My gut feeling is that most people are not able to successfully control a taper on a short acting opiate (which is what codeine, tramadol and dhc are) without medical supervision, and that if supervision with a stronger long acting opiate is the only option for someone who is already stuck in a cycle of relapse then it is probably the right route to take. Only you can make that decision though, think hard and be honest with yourself. If you take the script are you going to use it as prescribed or are you going to be banging it in your arm in a few weeks time? Just because it's a stronger opiate it doesn't necessarily equate to a step in the wrong direction because like you say it is (to some degree at least) about equivalent dosing, but you must be honest with yourself about your motivations.

I would also encourage you to start putting a recovery framework in place as soon as you're stable on any maintenance therapy you may engage with. Dont wait until you're drug free and suffering to create those structures, start doing it now whilst you have the crutch of the drugs so that when you're in that painful and naked feeling place after detox (and it will come at some point almost for sure) then you already have some stuff to help you navigate through it.

 

[FatBellyWhipSlay]

Yes that is a legitimate concern and you are right to think carefully before making that move. My gut feeling is that most people are not able to successfully control a taper on a short acting opiate (which is what codeine, tramadol and dhc are) without medical supervision, and that if supervision with a stronger long acting opiate is the only option for someone who is already stuck in a cycle of relapse then it is probably the right route to take. Only you can make that decision though, think hard and be honest with yourself. If you take the script are you going to use it as prescribed or are you going to be banging it in your arm in a few weeks time? Just because it's a stronger opiate it doesn't necessarily equate to a step in the wrong direction because like you say it is (to some degree at least) about equivalent dosing, but you must be honest with yourself about your motivations.

I would also encourage you to start putting a recovery framework in place as soon as you're stable on any maintenance therapy you may engage with. Dont wait until you're drug free and suffering to create those structures, start doing it now whilst you have the crutch of the drugs so that when you're in that painful and naked feeling place after detox (and it will come at some point almost for sure) then you already have some stuff to help you navigate through it.

Thanks again, your posts make complete sense.

As far as using as using as prescribed I have to do a daily SC (supervised consumption) with the pharmacist. So they basically take u into a little room and witch you take it. Also I am on Espranor 2mg which (unlike subutex or suboxone) is a little freeze dried wafer you place on your tongue and it dissolves immediately, you then have to not swallow for 5 mins, so i dont think the risk of me abusing it are an option. Apparently the clinic i go to has switched to this brand to avoid even more abuse and its quicker for the pharmacy. It also is meant to have a better bio-availability, whatever that means!!

As far as putting a recovery framework into place I am unsure of where to start. I have tried the 12-step plan most clinics use and also had some CBT, not sure if i didnt let it but it didnt really work for me. I dont have any peer impact on my usage as all of my friends are drug free and have been for a quite a while so its definatley not "who i hang around with" and changing my circles. Its definatley going to come down to myself and the reasons I have but I dont know where to start to get helpful for that.

My wife has been great support but even that is now starting to wear thin as she is getting sick of the lies and deception that come with addiction, i even screwed up the family Xmas holiday in spain...

 

[THECATINTHEHAT]

Supervised consumption usually only lasts a couple of weeks and then if they trust you that let you take it away each day, and then they'll give you a few days at a time, and then a week at a time. It's an absolute ballache going to the chemist every day and depending what the pharmacist is like they might make you stay for up to 20 minutes. I had a decent one who would let me go after a couple of minutes, but I used to keep that shit in my mouth for like an hour every day to get the most out of it and 24mg still never kept me good for 24 hours (but that's just me).

Recovery framework basics:

Reasonably healthy balanced diet
Some sort of link with other people in recovery you can talk to and go through the journey with.
Close relationship with at least a couple of individuals with whom you can be emotionally honest and communicate openly. Maybe ask a couple specifically for support with what you're going through.
Good relationship with your drug worker.
Have some active interests/pursuits that you enjoy to do in your free time.
An exercise regime that will make you reasonably fit and healthy.
Plan and prepare for a detox (when/where/who/how).
Realistically probably get a therapist.


You can work on all of that whilst you are tapering, more than enough to be getting on with!

 

[Jabberwocky]

i'd pick bupe over NHS detox, but i've done neither. a good friend is currently on bupe, and has been through NHS detox. she continued using through detox, was sexually assaulted by another patient, they fucked up her medication for some medical problems she has, didn't give her halal food (ok this may not be an issue for you lol), gave her no therapy, nothing, it made her worse cos of how traumatic some of her experiences were. bupe on the other hand has stabilised her. she is still on supervised consumption 5 days a week and is 9 months in. she was using DHC and i don't think she's making a mountain out of a molehill.

are your family on board? you need as much support as possible, both from those close to you, drugs service and doctor, and other addicts. for the latter i go to NA, but if you don't fancy that try SMART and groups at your local drugs services. you need to address the psychological need that using was fulfilling for you.

 

[FatBellyWhipSlay]

i'd pick bupe over NHS detox, but i've done neither. a good friend is currently on bupe, and has been through NHS detox. she continued using through detox, was sexually assaulted by another patient, they fucked up her medication for some medical problems she has, didn't give her halal food (ok this may not be an issue for you lol), gave her no therapy, nothing, it made her worse cos of how traumatic some of her experiences were. bupe on the other hand has stabilised her. she is still on supervised consumption 5 days a week and is 9 months in. she was using DHC and i don't think she's making a mountain out of a molehill.

are your family on board? you need as much support as possible, both from those close to you, drugs service and doctor, and other addicts. for the latter i go to NA, but if you don't fancy that try SMART and groups at your local drugs services. you need to address the psychological need that using was fulfilling for you.

Thats rough m8 I definately dont want to do that!

I decided yesterday that I was going to start the bupe so I took my last does last night and got my wife to chuck the rest of my stash out

Woke up starting to feel shitty which I do everyday, it will get worse as the day goes on but at least I will find relief tomorrow. TBH day 1 is not normally that bad for me, day 2 onwards is though.

 

[Phoenix_rising]

Bupe is good for getting stable as long as it's used short term,the longer you're on it the harder it's to get off of.

Another good thing about bupe is that it's sits in the receptors so well that other opiates can't get in. I tried it a few times and found it a complete waste which helped to break the cycle.

This is a brilliantly informative link

Tapering off buprenorphine - Taper Schedule - Taper calculator

How to conduct a comfortable taper off of buprenorphine. Create a customized taper schedule with the taper calculator.

www.helpmegetoffdrugs.com

 

[VanOccupanther]

Let us know how you get on. I’m currently tapering off of bupe. I’m down to 1.6mg having been on 8mg for a couple of years and I must admit it’s not easy! I think it’s important to do as much research as possible and talk to as many people as possible who have been through it. I was quite flippant about getting on, although I was in a mess back then (mostly oxy and dhc) and it’s harder than I expected to get off. I think in your particular case starting at 2mg will make it a lot easier, my advice would be not to stay on it for too long! It’s seems mad now that I’ve been on it for three years!
Good luck!

 

[VanOccupanther]

Bupe is good for getting stable as long as it's used short term,the longer you're on it the harder it's to get off of.

Another good thing about bupe is that it's sits in the receptors so well that other opiates can't get in. I tried it a few times and found it a complete waste which helped to break the cycle.

This is a brilliantly informative link

Tapering off buprenorphine - Taper Schedule - Taper calculator

How to conduct a comfortable taper off of buprenorphine. Create a customized taper schedule with the taper calculator.

www.helpmegetoffdrugs.com

Sweet man this link is great for me!

 

[THECATINTHEHAT]

gave her no therapy, nothing,

Not to excuse the other issues your friend had, but to receive no therapy is perfectly normal. A detox is simply that, the time and place to stop taking drugs that cause a physical dependency. It is not a time/place for spiritual or emotional healing, that can't really happen whilst you're going through the pain of detox and certainly not in that amount of time. Some programs may have you doing therapy at the same time as your detox, the treatment centre I went to would have you in group therapy vomiting in to a bucket rather than lying in bed, but that's not the norm.

No one should go in to a detox thinking it is going to help you fix your drug problem, it is a treatment to break from the physical dependency and nothing more.

 

[FatBellyWhipSlay]

thanks for all your replies!

Im also worried about going in to PWD, I took my last does of codeine and Tramadol last night about 6pm and havent had any since, im starting to go into wd's and I start the bupe at 830am tomorrow morning

will i be ok ?

 

[THECATINTHEHAT]

You'll be absolutely fine, at this point I'd be more worried about making it until 8.30 tomorrow without using.

Pretty sure I only left like 10 hours between my last bag of gear IV and first bupe when I switched. I also used on top and saw other people use on top so the precipitated withdrawal thing is not a given by any means, it's really quite complicated imo and everyone is different. To me you sound like you have left LOADS of time between last use and first bupe so you should be fine because you're going to be really ill and crying out for something by tomorrow morning.

Trust me you'll be a mess and that bupe will probably be the best hit of your life lol. Certainly if you're used to oral consumption then sublingual is going to be a novel experience for you because it comes on much faster.

 

[euphoricc]

yes u will be ok i like to give 24hours cause them pwd are insane but with codein and tramadol u really need bupe tho???

 

[euphoricc]

ur bag of gear wasnt half as strong as 1 old bag it`s all fent now i work at adult & teen challenge here and i`ve tested dirty urine for a living lol i havent seen ``true`` heroin in about 4 year`s, now

 

[THECATINTHEHAT]

That bag of gear was done about five and a half years ago, do try to engage your brain before the keyboard.

 

[THECATINTHEHAT]

Also I'm in the uk, and we don't have the same extent of fentanyl contaminated gear here that is in the US.

You see how it's important to consider that other people have experiences different to our own, a different environment etc before we talk in absolutes and tell people that we know something about their experience?

You might also want to consider typing like an adult if you want to be taken seriously.

 

[VanOccupanther]

Yeah they recommended to me that you wait until you start to get the W/ds before you dose with bupe, sounds like that is already happening for you, so I suspect you’ll have a rough night but the bupe will give you relief in the morning.

 

[FatBellyWhipSlay]

Thanks for all the info.

So its getting worse as the hours crawl on but I'm not going to cave and will wait till the morning, I have no 'stash' left anyway and want to do it right so I'm just going to lay on the sofa and wait....

I panicked and rang the pharmacy to check they have got it in and they have, so I'll just wait now and post back after my first dose...