Bupe: The Less Is More Myth Exposed

[smackem]

Here is what the suboxone doctor had to say.. Keep in mind, he is an anesthesiologist as well.

I will get to the bluelight post when I have a chance later today. I really need to learn more about the basic science of bupe at the receptor level-- unfortunately the chemical is 30 years old and generic, so there is not a great deal of interest in studying the chemical itself. Maybe that will change... but I came across a paper a couple years ago that showed that at the mu receptor, buprenorphine is an agonist up to a certain point, and then it hits a ceiling-- but at very high doses it actually starts to antagonize itself. At the receptor, we are talking about molecules that are attaching and releasing very
quickly-- there are 'association constants' and 'dissociation constants'
that determine the overall degree of binding at the receptor. The agonism/antagonism is a different issue, and relates to the changes in shape of the receptor site that occur when bound vs when not bound with drug. To have mixed properties, you need to imagine the receptor site as having several different binding configurations; one configuration is favored when bupe is in low concentrations (the 'agonist'
configuration') and another when in high concentrations (the 'ceiling
configuration') and maybe a third where in super high concentrations, but bupe will bind to a lower-affinity configuration that shapes the receptor in a way where it acts as if nothing is bound to it, and nothing CAN bind to it-- the 'antagonist configuration'. This is all guesswork on my part based on how other receptors work in general-- I don't know if anyone has defined these specific properties to the mu receptor and buprenorphine.

 

[ashla]

when i first went to the doctor to get prescribed bupe he started me on eight (in the office) i truly felt good after that but my addictive mentality was wow if eight does it sixteen will be so much more, so i told the doctor " oh i feel a little better but still not great" he did not check my cows or anything just gave me another and then said if you still need more you can take another four mgs later tonite, i believe personally that it is all about money no matter how you look at it and the naabt and Reckitt-Benckiser are of course going to respond to something like this with a letter of that nature, personally i have been going back and forth with the less is more theory myself for a long time but before i even read there letters i knew what they would say , what truly do we think they will say , if they start prescribing lower doses of subutex , alot of people loose money the company that makes the subutex/suboxone, the stock holders (wow wish i would have invested) and also the doctors, my doctor loves keeping me on a high dose, he can make me pay out of pocket for my visits and there are very few docs where i live that even do dose sub, and if i started out at a lower dose i could come of alot easier would have gotten of alot quicker, because no matter what my mind tells me that 20 mgs is alot of bupe to withdraw from and i better take it slow, that may not be the case with everyone , but i know that when i was doing ten bags of heroin a day i knew it would be worst than when i came of one a day, i still do not know where i stand on the less is more theory for myself, i do know though that i knew exactly what they would write back saying, everyone has to come to there own conclusion on the less is more theory , just because these companies tell us something dont make it completely true, its just like politicians we have to take everything they say with a grain of salt . just my two cents

 

[sneakdiss]

Here's my take on it;

If you've been heavily using opiates, the day you come off and withdrawal you're going to need more suboxone than usual to hold off your symptoms and you're not going to feel much of a buzz from the suboxone. You're just going to feel somewhat stabilized from it.

I find it takes about 4-5 days for the side effects of former opiate that was being abused to leave my system. After my brain/body has recovered from that, I don't have to take a high amount of suboxone at all. 1-2 mg seems to be the perfect dose for me at this stage of recovery. I also seem to catch an agonist-like buzz at this stage. Whereas when i was coming off i'd take 4-6 mg and just feel normal.

This tells me that I've detoxed myself from the former opiate and I should now start to taper from the suboxone.


So I'm with the group that thinks any dose more than 8mg is excessive and pointless. I also understand that the farther you get away from the opiate you're abusing that you can take LESS suboxone and get MORE effect from it.


This is where the less is more theory proves to be right in my experience.

 

[Cane2theLeft]

^this is exactly what I meant when I said people see their experiences as inviolable truth.

Because YOU didn't need that much sub NO ONE could need over 8mg? That logic is absurd.

 

[sneakdiss]

Let me clarify...

After you've detoxed from the previous opiate, anything above 8 mg is definately excessive. While you're detoxing it's on you to find that sweet spot that makes you feel right. But in all honestly I've abused heavy duty opiates in heavy amounts and there is very little difference between say 8 mg of suboxone and 16 mg of suboxone in terms of relief and in the end you're going to be facing a much harder battle getting off suboxone.

I'm not saying doctors should prescribe less (so stop freaking out junkies!). I'm saying users should dose less and save more.

 

[Cane2theLeft]

That is how YOU felt, what worked for YOU. Some people don't feel held on 2 or even 3x the 8mg pill dose and you are saying how they FEEL is wrong? I don't understand that.

Of course people should always try to use the smallest dose possible but your experience doesn't dictate how other people will respond to buprenorphine.

Also, I am not a junkie. My only experience with opiates is taking them for pain, I have severe nerve damage and am prescribed 30mg of hydrocodone a day currently and have chosen to go down to that level after previously needing morphine or oxycontin.

I am going to be working soon as a drug counselor so my interest in this subject is academic and professional, not personal. I am not arguing, "I want more sub so I can get fucked up!" I am arguing, "Stop telling people they can get by on less because you can. Maybe most people only need a small amount, but saying that's true of all is detrimental to those who do need more".

To all other sub users- Have you found the same thing... That you needed more to feel well while detoxifying than you would need to feel maintained sufficiently after those first few days?

What you are saying about needing more initially sounds logical so I'd love to hear other people's experiences. Thanks in advance to any who respond to this... as I said above, I will be working with addicts soon and I just want to have to best understanding of these situations.

 

[Captain.Heroin]

To all other sub users- Have you found the same thing... That you needed more to feel well while detoxifying than you would need to feel maintained sufficiently after those first few days?

What you are saying about needing more initially sounds logical so I'd love to hear other people's experiences. Thanks in advance to any who respond to this... as I said above, I will be working with addicts soon and I just want to have to best understanding of these situations.

For me, yes. When I was first coming down, I took 2mg 3x a day.

Within that same week, I noticed I only needed 2mg 2x a day.

Eventually, I got down to 1mg 2x (sometimes 3x or 4x a day, depending on how busy I was). I stayed at this dosing range for a few months, and eventually each MG I would take would get me significantly high (at first it was just enough to get through the day - what a relief that is for maintenance doses to become recreational), and that's when I noticed I should keep tapering down.

Now I'm at 0.5mg 2x (sometimes 3x) a day. This holds me the best of all. Now that I take 0.5mg 2x (at the most 3x) a day, I wake up with the least WD symptoms, I have the most pleasant effects (I'm guessing more norbuprenorphine makes its way to the receptors), and it seems to be the least irritating/agonizing dose. It was unpleasant to jump from 3mg (2 days ago) to 1.5mg (yesterday) to 1mg a day (today), but now I'm not feeling anything except pleasant, and a lot more clearheaded than I was many months ago.

 

[Cane2theLeft]

Thanks for the response... The more I learn from you guys the more informed I can be treating people. I appreciate it

 

[Captain.Heroin]

No problem.

If it is any help, heroin was my DOC before beginning suboxone. I tried other opiates prior to heroin, but never found them addictive like heroin is.

I don't know what specific job you got, but congratulations on it and I wish you the best in treating patients.

 

[Johnny blue]

For me, yes. When I was first coming down, I took 2mg 3x a day.

Within that same week, I noticed I only needed 2mg 2x a day.

Eventually, I got down to 1mg 2x (sometimes 3x or 4x a day, depending on how busy I was). I stayed at this dosing range for a few months, and eventually each MG I would take would get me significantly high (at first it was just enough to get through the day - what a relief that is for maintenance doses to become recreational), and that's when I noticed I should keep tapering down.

Now I'm at 0.5mg 2x (sometimes 3x) a day. This holds me the best of all. Now that I take 0.5mg 2x (at the most 3x) a day, I wake up with the least WD symptoms, I have the most pleasant effects (I'm guessing more norbuprenorphine makes its way to the receptors), and it seems to be the least irritating/agonizing dose. It was unpleasant to jump from 3mg (2 days ago) to 1.5mg (yesterday) to 1mg a day (today), but now I'm not feeling anything except pleasant, and a lot more clearheaded than I was many months ago.

Same. My DOC is oxy and I also found I need more bupe the first couple of days than those that follow. To me anyway, I didn't need more to fight physical wd it was solely to fight mental cravings.

Day 1-2 2mg a day. Following that about .5mg a day, sometimes twice a day depending on whether or not I ran into a trigger. After about a week and a half I can stop all together with little to no physical symptoms present. Of course I always keep some on hand in case of a major trigger but anything short of being offered drugs and I'm fine.

Clearheaded is a great explanation of the feeling. It literally feels that a fog has been lifted

 

[daddysgone]

i think this thread has become way more complicated (and aggressive) then is necessary. Like ANY medication, the goal is to taking the lowest dose that still provides the desired effects. As with any medication, sometimes docs overprescribe and at times underprescribe medication.
It seems that MANY people here on BL seem to feel that their doctors prescribe them much more bupe then is necessary. i think it IS significant that bupe seems to be the one medication that comes up again and again in reference to being overprescribed. very rarely do people here state that they feel their xanax or oxycodone dose is too high. so again, when u see poster after poster state that they get by just as well if not better on a lower dose, then i think there has to be some truth to this. of COURSE this does not mean that ALL people require lower doses, but it is significant when so many people report that they feel they are overprescribed.

 

[Captain.Heroin]

Though you do say that, I did see someone who complained of too high a xanax dosage.

They said they were instructed to take 10mg daily, and when they complained that that didn't work, the doctor added 10mg of clonazepam into the mix, daily.

I was like, wow, really? That's a lawsuit waiting to happen.

This was someone else's story, I forget whose though. I felt bad for them.

 

[Cane2theLeft]

Captain- I don't have a job yet, I guess 'someday' would be more appropriate that 'soon'. I am in school right now working on my certification to treat alcoholics and drug addicts. Next semester I'll be doing an internship at a local counseling center that does levels 1-3 (varying amounts of outpatient counseling hours per week, level 4 is in-patient) and after my internship I'll be certified.

When I first start working I'll primarily be doing intake assessment most likely and basic counseling stuff so of course I won't be able to prescribe medications or anything, but I will be working with doctors and will have a lot of input into who gets bupe or other medications, how much, etc. I'd really like to get a medical degree eventually so I can work independently and Rx bupe and such but I'm not sure if I will pursue the MD or the Ph.D.... but that is a ways off.

Johnny- I really appreciate that you shared your experiences. Thanks... as I said, the more I learn about people's experiences, the more effective I can be in my field. I see so many people suffering and I just really want to do what I can to relieve that and help people move forward in life.

Daddysgone- I very much agree... I probably was too aggressive and I regret that. I just want good dialog to further my own education and the collective discourse and these arguments aren't beneficial.

 

[bluemorning]

To all other sub users- Have you found the same thing... That you needed more to feel well while detoxifying than you would need to feel maintained sufficiently after those first few days?

What you are saying about needing more initially sounds logical so I'd love to hear other people's experiences. Thanks in advance to any who respond to this... as I said above, I will be working with addicts soon and I just want to have to best understanding of these situations.

I'm not even going to get into this whole "less is more" thing, but I will chime in to agree with this statement in MY experience.

My doctor RX'd me 16mg per day initially. For the first few days off of dope, I would take 8mg in the morning, and around late-afternoon/early-evening, I would start getting restless, achy legs, watery eyes and non-stop yawning, so I would take another 8mg, and when I woke up the next morning I was miserable and needed another 8mg before I could even consider crawling out of bed.

Within a week, I was taking 4mg twice a day.

The taper down to 1mg 2-4 times per day has been infinitely harder (and has taken about 6 months).

So I will second the notion that some people, such as myself, need a significantly higher dosage in the first few days of detox.

As far as cravings, no amount of bupe has ever eliminated my cravings, but I know that for many, it does.

 

[Tchort]

Something that no one has mentioned specifically which probably plays a huge factor in all of this- personal experience, the studies, literature, etc- is that Buprenorphine is one of the easiest opioids to make dose changes with, up or down, without experiencing moderate (or any, often times) withdrawal symptoms, discomfort or side effects. The same can be said of other long half-life opioids to an extent, only some like Methadone and LAAM seem to have a 'wall'; a patient will be able to painlessly reduce their dose on a taper until they hit a seemingly arbitrary dose and experience moderate to severe discomfort if they try to go below this point. This feature seems absent from Buprenorphine, as I haven't read any personal reports/experience reports that indicate this kind of response.

 

[pinpoint]

nobody should take anything on these forums as fact unless it is backed up with a source from an .edu or .gov .mil website. Even if a mod says something don't take it as fact unless it can be backed up.

 

[formanchristopher]

"Less is better"....

To the OP

This is a great thread, and im glad you posted the replies from those 2 authorities. however, you end your post saying "the less is more theory is bunk".
Im not sure how you reached this conclusion based on the responses you received, especially the one from B-R. I dont think anyone takes (or should take) the "less is more" idea literally. obviously less is always less and more is always more. its a tautology. less can never LITERALLY be more. a more accurate mantra could be "less is better". and when it comes to bupe, less often is better, and even the makers of bupe seem to indicate that less bupe can often be better. bupe is rarely if ever underprescribed. ive NEVER heard of someone who says, "im trying to get off oxy but my bupe doc only gives me 4 mg a day and it wont hold me and he refuses to up the dose". however there are many many people who are scripted 32mg a day who quickly find that 6mg a day holds them perfectly well.
I know that i was scripted 24mg a day, and at this dose i felt very lethargic and foggy. after a week i tried taking 2 mg 2x a day and i had zero cravings also felt much more energetic and clearer headed. So for me, and many others, less is definitely BETTER when it comes to bupe.
So again to sum up- Less it not more..because less is always less-it has to be. but when it comes to bupe, less can be BETTER because docs very often prescribe a much higher dose then what is needed to hold ones cravings and WD at bay. These high doses often provide no added benefit, but carry with them, unneeded side effects

It's my own personal use, opinion, and tons of other's stories, combined with what I almost could not believe the pharma. co. sent you (it really all DOES boil down to money!), that makes me believe that DaddysGone has pegged it perfectly..."less is better". However, less is better only after one has been stabilized. It's ridiculous to even think that 2mgs is gonna help someone with a gram a day heroin habit, out the gate. But the facts speak for themselves: All
those who have posted along these lines continue to repeat the same things over & over & over: I cut back to 2-4mgs a day, and it works just fine.
I hate what one Addiction teacher said to me once, about how the addict has that, "monkey brain" (the part that causes the cravings, triggers, relapses, etc.) and I find that it's exactly that, the monkey brain part of my brain is what makes me (and others?) want or need to have the desire to take more. I'm here because I support Harm Reduction 100%, and also because even in my mid 40's, I've "aged-out". Meaning, I'm tired of the game, the chase, the life I use to live. But, it seems my monkey brain will never tire of getting "high", and that's such a bitch! Because of buprenorphine, I live a fantastic life today, coupled w/ AA/NA mtgs. However, because of the monkey brain, I STILL try to find ways to "enhance" or divert, in order to get more of the same thing I've chased for 20 yrs.....euphoria. You know, once you've been to heaven (opiate euphoria), who wants to come back to living in hell ( normal everyday existence)?? That's the metaphor I always use anyway.

Peace to all of you, and "thanks" tchort, for even taking the time to research this stuff, regardless of your underlying agenda.

 

[formanchristopher]

when i first went to the doctor to get prescribed bupe he started me on eight (in the office) i truly felt good after that but my addictive mentality was wow if eight does it sixteen will be so much more, so i told the doctor " oh i feel a little better but still not great" he did not check my cows or anything just gave me another and then said if you still need more you can take another four mgs later tonite, i believe personally that it is all about money no matter how you look at it and the naabt and Reckitt-Benckiser are of course going to respond to something like this with a letter of that nature, personally i have been going back and forth with the less is more theory myself for a long time but before i even read there letters i knew what they would say , what truly do we think they will say , if they start prescribing lower doses of subutex , alot of people loose money the company that makes the subutex/suboxone, the stock holders (wow wish i would have invested) and also the doctors, my doctor loves keeping me on a high dose, he can make me pay out of pocket for my visits and there are very few docs where i live that even do dose sub, and if i started out at a lower dose i could come of alot easier would have gotten of alot quicker, because no matter what my mind tells me that 20 mgs is alot of bupe to withdraw from and i better take it slow, that may not be the case with everyone , but i know that when i was doing ten bags of heroin a day i knew it would be worst than when i came of one a day, i still do not know where i stand on the less is more theory for myself, i do know though that i knew exactly what they would write back saying, everyone has to come to there own conclusion on the less is more theory , just because these companies tell us something dont make it completely true, its just like politicians we have to take everything they say with a grain of salt . just my two cents

For what it's worth...here's a 2008-09 book that states just what this person is trying to say, I believe. Its titled:
"Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs". Written by, Melody Petersen, and I just read it over the weekend and must say...doctors being PAID to prescribe? Doctors being given lavish weekends, lunches, dinners, etc., all so that they will push, push, push
these drugs, even IF the evidence doesn't fit the protocol for such prescribing.
Eye opening, for anyone who truly does want to know what's really going on, without the paranoid delusions sometimes accepted when it comes to huge corps. like these drug companies. Money? It's all that matters...believe that!

 

[ashla]

hi to forman chris i just recieved your pm but i cant respond since i am greenlighter it says, but sure anytime you want no problem

 

[Z Y G G Y]

Sub will be available in generic form this year in October. Hooray!!!

The patent expires later this year. I'll search the web for the exact source.

First heard it from my sub doc recently, he wasn't sure what month exactly, he thought it was sooner, but looks like October since that's when the patent expires.

http://www.baltimoresun.com/news/nation/bal-te.orphan18dec18,0,3140054.story
"Reckitt Benckiser's exclusive rights, which would have expired without buprenorphine's orphan drug status, last until October 2009. Within a year after that, its drug division expects to lose 80 percent of its U.S. sales, according to a company presentation for investors."

So after October 2009 we can expect a generic version. I'm sure other companies benefiting from the ending patent will be getting ready before October 2009. So we can expect a generic as soon as October 2009 starts. Might take a little longer than that, might not, but we are 100% sure it will happen soon after Oct 2009.