Buprenorphine "Ceiling effect," Heroin, Methadone, and you

[diacetyldeath]

All,

I searched and searched for this, so just point me in the right direction if I am beating a dead horse.

I've read in several places that Buprenorphine has a ceiling effect (its mu agonization levels out as dose increases after you reach a certain dose plateau). The suboxone pamphlet I was reading stated that 12-16mg of suboxone is equivalent to 50-80mg of methadone, but above 16mg, the equivalence to methadone was difficult to understand because of this ceiling effect and also because of the partial agonist effect and higher mu affinity of buprenorphine compared to most other opiates.

I would like to just get some responses from those of you who have attempted buprenorphine maintenance:

1. What were you using before you started buprenorphine? How much of it were you using per day? (e.g. Heroin, 1/2 gram per day)

2. What dose did you start with on buprenorphine induction? How long did you wait after your last opiate dose until your first dose of buprenorphine?

3. What dose of buprenorphine did you eventually stabilize on?

4. Was buprenorphine effective for you once you stabilized?

When you shared your habit with your doc, did any of you get placed on methadone instead of buprenorphine just because of the intensity of your habit?

I'm using around 0.75 - 1g/day of heroin IV. I'm afraid that buprenorphine won't really help my withdrawals and that I'll be in agony for two weeks. Sigh. I can't do methadone.

Any help is appreciated.

 

[adradmin]

1) Heroin, roughly 3-5bags per day sniffed (1/4g of tan powder at the MOST spread thru the day).

2) 4mg bupe, 14hrs (bupe is over-prescribed. dont get on a higher dose than u need. i kno this one doctor who gives out 32mg to EVERYONE that comes in. for my friend, i kno for a fact 8-12mg would hold him definitely, but instead hes taking 32mg to be "safe" - have fun tapering off that shit especially with the long ass halflife).

3) 2mg bupe, and eventually did a slow taper. withdrawal never showed its ugly face until i started tapering that last bit from 1mg and below. i couldn't sleep for days and had some rebound anxiety. make sure towards the end u taper SLOWLY.

4) yes i stabalized on it for a few weeks and killed ALL of my cravings to even touch dope.

i get these off the street for about 10$ and stock up whenever i can. its a lot easier to just jump off an H habit with these, and i decide when i want to binge or not. in my case its better to not deal with a doctor and all the bills.

 

[diacetyldeath]

Anyone else? My habit is a lot more ridiculous than 3-5 bags/day sniffed. That was my habit in December, but since then it's more like 18-24 bags IV. He prescribed me 3 8mg suboxone, but said I could take 4 if I was not feeling well. But (like everyone says), above 4 really isn't effective.

So I just wanted some firsthand accounts of some heavy users who switched to bupe and whether they encountered this ceiling effect in a negative fashion.

Someone mentioned switching from using a gram a day, that account was encouraging, but I will need to find a time when I can give up 2-3 days to agony.

Thanks for your response!

 

[1badrabbit]

1. What were you using before you started buprenorphine? How much of it were you using per day? (e.g. Heroin, 1/2 gram per day)

Anywhere from .5-2gms of black tar heroin per day. Sometimes almost .25gm in one shot.

2. What dose did you start with on buprenorphine induction? How long did you wait after your last opiate dose until your first dose of buprenorphine?

My doc gave me 2mg initially, and sent me with 4mg to take as I wished the rest of the day. I waited about 24 hours from my last shot of dope before taking bupe.

3. What dose of buprenorphine did you eventually stabilize on?

Doc wouldn't script more then 24mg per day. Thats where I was at when I quit using bupe altogether.

4. Was buprenorphine effective for you once you stabilized?

Honestly no it wasn't, and everyone seems to think I didn't do it right or something. But it just wasn't working for me, I got terrible headaches almost daily. The Dr. said he wouldn't script me subutex no matter what, and if I didn't like the headaches to find something else to take myself. Also even at 24mg after a month or so clean I still felt uncomfortable temperature wise sometimes. Almost like hot/cold flashes and uncomfortable feelings mostly at night. In addition I had insomnia most of the time even if I took some sub before bed. Finally the cravings just didn't seem to subside now that could be me mentally but either way they didn't. Other noticable effects were I had no sex drive, energy, or motivation most of the time on the stuff. My Dr.'s response to this was that it would go away just give it time. When I asked about something for the uncomfortable feelings and insomnia he said absolutely not. After 3 months the symptoms hadn't improved so I called it quits and went back to junk. Maybe part of my bad experience is due to the Dr. I had to deal with but since switching to methadone I have been much happier.

When you shared your habit with your doc, did any of you get placed on methadone instead of buprenorphine just because of the intensity of your habit?

No he said that the size of my habit was still fine for bupe. Oh and I doubt that 12-16mg of sub is equivalent to 50-80mg of methadone. Because you can't even transfer from methadone to sub unless you on 30mg or less per day of methadone because the sub won't keep you out of withdrawals. You would have to taper to 30 or less to switch to sub from methadone.

For me personally methadone has worked 100% better, and I know that its harder to get off of etc. But the good outweighs the bad for me since methadone has helped keep me clean thus far. However getting the sub in the simple office setting is sooooo much nicer then going to the clinic every fucking day. Sorry to ramble man hopefully some of that was helpful for you.

 

[Dr.groveller]

So I just wanted some firsthand accounts of some heavy users who switched to bupe and whether they encountered this ceiling effect in a negative fashion.

Someone mentioned switching from using a gram a day, that account was encouraging, but I will need to find a time when I can give up 2-3 days to agony.

Thanks for your response!

You've seen my accounts- from what I remember- from a gram/day I started at 24mgs of suboxone, tapered down over a month to being clean. Did that a second time from a bit more of a habit 1.5/day or so, believe I might have upped to 32, but maybe 24 was enough- tapered down over a month to clean. Once I was up to 2 g/day, I could never seem to get switched over to bupe successfully, but that was just me- I know it can be done.

But here's the thing- if you want to quit- quit now- don't wait for that perfect time- it won't come. I sort of get the feeling you kind of want to quit, but aren't really committed to it. In which case, spending the time and effort to get on suboxone will be wasted- been there done that. I've kicked many times when in the back of my head, I flat out didn't want to- never worked- lots of pain and suffering for no gain, and then just feeling guilty as shit when I went back out.

The last time I kicked it was one of those things- I was sitting there and I thought, "I really want to quit this time" and immediately flushed the remaining dope I had and headed for a friend's house to lock away.

And I think you're still building up the w/d's way too much. If you've ever kicked cold turkey before, suboxone will seem like dream land comparitively.

cheers
doc

 

[diacetyldeath]

But here's the thing- if you want to quit- quit now- don't wait for that perfect time- it won't come. I sort of get the feeling you kind of want to quit, but aren't really committed to it. In which case, spending the time and effort to get on suboxone will be wasted- been there done that. I've kicked many times when in the back of my head, I flat out didn't want to- never worked- lots of pain and suffering for no gain, and then just feeling guilty as shit when I went back out.

I'm sorry if I gave you the impression that I wanted to quit for life. I want to get clean for now because I do not have the financial resources to support a safe habit (one in which I won't get arrested) along with the rest of my life.

Unlike most of our culture/society, I have no problem with becoming dependent on a substance that makes me happy, if that substance has no long term physiological harmful effects (opiates don't), and if I can maintain said habit without damaging the professional, social, emotional, and leisure/hobby portions of my life. "Better living through chemistry" is something with which I can identify.

Unfortunately, at this moment my habit is eclipsing my finances. Spending $200/day on average is something I cannot maintain for more than a few months, unless I want a foreclosure, and horrible credit.

My professional situation is looking up, and I am hopeful that within the next five years I will have accumulated enough money to be able to responsibly restart my habit, this time armed with some knowledge about ultra low dose antagonist therapy to keep my tolerance negligible.

So my goal with buprenorphine is to maintain myself until I can afford H again. If I stated that quitting was my goal, I apologize for being misleading. Just don't tell my doc.

That said, your advice still applies. I know that playing the waiting game is basically a thinly veiled excuse. But I do have a week's vacation coming up and I think it will be a perfect time to switch to bupe, and at that point maybe even reward myself with a short trip somewhere with the money that I would have spent on heroin during that time.

And I think you're still building up the w/d's way too much. If you've ever kicked cold turkey before, suboxone will seem like dream land comparitively.

I'm glad to hear that. I've kicked cold turkey before when I was snorting 2-3 bags/day, when I was snorting 5 bags/day, and when I was snorting around 10 bags/day. When I tried to kick cold turkey when I was IVing around 15 bags/day, I didn't even make it 12 hours. I was positively writhing in pain, screaming, crying, unable to walk, etc. I was unable to sleep despite having taken 3mg clonazepam, 150mg trazodone, and 90mg seroquel. It really sucked. From what you say, this will be better. I just want to be able to sleep.

Thanks again for all your help.

 

[Dr.groveller]

I'm sorry if I gave you the impression that I wanted to quit for life. I want to get clean for now because I do not have the financial resources to support a safe habit (one in which I won't get arrested) along with the rest of my life.

Unlike most of our culture/society, I have no problem with becoming dependent on a substance that makes me happy, if that substance has no long term physiological harmful effects (opiates don't),

Pure, medical grade opiates are not physiologically toxic. However, you're shooting street dope. Come on, don't kid yourself/me. I'm all for people making their own choices, but I played that "opiates aren't harmful" game too. Shooting street dope is not "safe" by any means. I still had a grand old time for a long time doing it. And I'm not trying to convince you not to- in fact- if I *could* maintain a "reasonable" habit- and I don't mean financially- that I can do, I probably would. Me, I can't- everything around me suffers eventually- but that's m.

and if I can maintain said habit without damaging the professional, social, emotional, and leisure/hobby portions of my life. "Better living through chemistry" is something with which I can identify.

It's the whole reason I loved dope from the first time I did it. It's the whole reason I *happily* picked up a daily habit not long after. I completely understand this desire. I just can't seem to strike that happy balance. It stayed that way for a long time, then spiraled. When I went back out this last time, it stayed that way for probably 6 months, and then a year after that I suddenly realized I did nothing but "shitty work" at my job, and shoot dope. I did NOTHING else in my life that used to mean the world to me.

My professional situation is looking up, and I am hopeful that within the next five years I will have accumulated enough money to be able to responsibly restart my habit, this time armed with some knowledge about ultra low dose antagonist therapy to keep my tolerance negligible.

I wasn't even talking long term quitting above. I just didn't get a strong feeling you were that committed to detoxing... I was back out within 2 months after each of my suboxone kicks. That was a waste- barely dented my tolerance.

So my goal with buprenorphine is to maintain myself until I can afford H again. If I stated that quitting was my goal, I apologize for being misleading. Just don't tell my doc.

If you're looking for maintenance- why not go mmt? It's a hell of a lot cheaper. If I was looking to quit- I'd go bupe, if I just wanted to maintain- I'd go mmt.

But I do have a week's vacation coming up and I think it will be a perfect time to switch to bupe

Definitely takes the stress of of worrying whether you'll be okay enough to make it into work.

When I tried to kick cold turkey when I was IVing around 15 bags/day, I didn't even make it 12 hours. I was positively writhing in pain, screaming, crying, unable to walk, etc. I was unable to sleep despite having taken 3mg clonazepam, 150mg trazodone, and 90mg seroquel. It really sucked. From what you say, this will be better. I just want to be able to sleep.

Sounds like a standard cold turkey kick from a decent habit. Yup, it SUCKS- and yup bupe is wayyyyyy better. Simple as that.

cheers
doc

 

[diacetyldeath]

Pure, medical grade opiates are not physiologically toxic. However, you're shooting street dope. Come on, don't kid yourself/me. I'm all for people making their own choices, but I played that "opiates aren't harmful" game too. Shooting street dope is not "safe" by any means. I still had a grand old time for a long time doing it. And I'm not trying to convince you not to- in fact- if I *could* maintain a "reasonable" habit- and I don't mean financially- that I can do, I probably would. Me, I can't- everything around me suffers eventually- but that's m.

Yes, the purity of street dope is worrysome. Hopefully someday I have the resources to find a reliable source of pharmaceutical morphine, which is readily converted into diacetylmorphine, and I can control purity myself. Alternatively, I would be just as happy with, say, IV oxycodone, but somehow I doubt I will be able to find a reliable source of it.

I have no problems maintaining a reasonable habit in every aspect but the financial. I respect that everyone's experience with this substance is different, and some are capable of things that others aren't. I know one person who does not find heroin the least bit addictive. She willfully stops using with plenty left over and doesn't again for weeks. I am simply unable to do so. Insidious substance.

If you're looking for maintenance- why not go mmt? It's a hell of a lot cheaper. If I was looking to quit- I'd go bupe, if I just wanted to maintain- I'd go mmt.

I'd love to. Unfortunately, the regulations surrounding methadone are completely insane. The nearest clinic to me is approximately 40 miles to my east. That means an hour and a half drive every day, plus the amount of time I spend waiting while incompetent people in an understaffed facility manage a completely inefficient process for my money. I often travel due to the role I play in my company as well -- I'm not sure how I am supposed to get back and forth to a clinic when I go to a city in which I've never been, without a rental car. I'm also not prepared to risk the contempt of every medical professional I encounter in the case that I have to go to an emergency room because I cannot find a clinic, or a clinic I find refuses to dispense to me.

Methadone is a much superior option for the strategy I wish to employ, but the culture and regulations surrounding it have made it totally infeasible. Which is quite a tragedy, really, because I'm sure there are a great deal of addicts in my situation.

I honestly believe that the aggregate time I would spend acquiring methadone would have more of a negative effect on my lifestyle than the time and resources I expend (financials notwithstanding) acquiring heroin.

Thanks again for all your help and taking the time to reply.

 

[blahblahblah]

1. What were you using before you started buprenorphine? How much of it were you using per day? (e.g. Heroin, 1/2 gram per day)


1A. Bundle of dope daily [11-13 bags, white dope], daily habit for past 5 yrs, prior to that last kick was in 97'ish [2 yrs on methadone]
1B. .5 gram [fluctuated between 2-15 bags] of white dope IV [daily habit for close to a year]
1C. Anywhere from 2-15 street bags a day IV [daily habit for 6 months or so]


2. What dose did you start with on buprenorphine induction? How long did you wait after your last opiate dose until your first dose of buprenorphine?


2A. 8mg's induction/19 hours after last dose
2B. 8mg's induction/24 hours after last dose
2C. 16mg induction/3 weeks after last dose


3. What dose of buprenorphine did you eventually stabilize on?


3A. Stable at 32mg's for about a year, than stable on 16mg's for another year, than a slow taper and a easy 'kick'
3B. Stable at 16mg's, decreased intake and stable at 1-4mg's, pretty painless kick
3C. Stable at 24mg's, currently stable at 2-4mg's


4. Was buprenorphine effective for you once you stabilized?

4A. Yes, completely
4B. Yes, completely
4C. Yes, completely


5. When you shared your habit with your doc, did any of you get placed on methadone instead of buprenorphine just because of the intensity of your habit?

5A. Offered methadone and I replied 'No fucking way'
5B. nope
5C. nope

Other meds I have been scripted while on Bupe [at one time or another]: Klonapin, Xanax, Ativan, Ambein, Lunesta, Clonadine, Trazadone, Halcion, Compazine, Zoloft, Seroquel, Thorazine, Rispedal, Adderall, and probably a few others I am forgeting

Other meds scripted while on methadone: Valium, ORLAMM, Clonadine

MMT does not offer the flexability to treat other disorders in the same way bupe does. There are many more complications with methadone and other meds. My doc was telling me that the DEA brach in charge of checking up on clinics would routinely go over prescription lists for patients on MMT and were very strict on what meds can be script to those on the program.

*I think my doc is being watched a little bit more closely than other bupe/methadone doctors for her prior medical practices

 

[lyserg]

Damn, those are some large habits. I couldnt imagine 18-24 bags a day. How long were you using again? Best of luck to all of you.

 

[diacetyldeath]

My buprenorphine induction

Well, in case anyone cares, I inducted on buprenorphine as of the past 36 hours or so. Here's the lowdown, and my subjective thoughts on the experience:

0 Hours: Final dose of diacetylmorphine, IV
1 hour: Sleep
10 hours: Awaken, 1mg clonazepam; sleep
12 hours: Awaken, minor pain in extremities, overwhelming feeling of anxiety.
15 hours: Pain became unbearable. Calling out/screaming in pain. Decided to insufflate 1/8 suboxone (approx. 1mg buprenorphine).
16 hours: Pain remains unbearable; 1mg lorazepam, another 1mg buprenorphine.
17 hours: Pain lessens a bit, still very uncomfortable. Insufflated additional 1mg of buprenorphine.
18 hours: Anxious and uncomfortable; pain has lessened. Insufflated 1mg of buprenorphine.
20 hours: Took remaining 4mg buprenorphine sublingually. Still somewhat uncomfortable.
22 hours: Pain is mild and transient. Still unable to get comfortable or sleep. Took hot shower, remedied remainder of leg pain for a few hours.
23 hours: Pain is bearable, mood is still anxious and uncomfortable.
24 hours: 1mg buprenorphine insufflated, 1mg clonazepam, 1mg lorazepam, 50mg trazodone
Sleep
32 hours: Awaken at 4AM, fairly uncomfortable, cannot get back to sleep. 2mg buprenorphine, 30mg seroquel
36 hours: Awaken. Begin normal regimen of suboxone with 8mg sublingually. No pain, mild dysphoria and anxiety.
37 hours: Another 8mg sublingually. Doc's instructions say to take up to 32mg per day depending upon symptoms.
38 hours: 4mg buprenorphine insufflated.
39 hours: Now. I basically feel "mostly normal." There are no withdrawal symptoms to speak of other than a bit of dysphoria and yearning for being able to put a needle in my arm to make things more interesting. I think they call this "craving" and I am supposed to take more of this insidious buprenorphine with its incredible half-life to deal with it.

Anyway, I won't rant or rave about my psychological well-being; the medication does what it purports to do, that is, maintain an opiate-dependent user in an opiated state so he does not withdraw.

Do I "catch a buzz" off buprenorphine? Definitely not. As I sit here typing this, I feel a shadow of the characteristic warmth that envelops me when I do any other opiate, but that fizzy/spinny head feeling and pulses of warmth in the pit of my stomach are definitely not here. I am by no means intoxicated, nor was I at any point with buprenorphine.

My habit at the time of induction was down to about a bundle a day, down from 20-25 bags/day before I started my ULD Naloxone experiment three weeks ago.

On the other hand, buprenorphine has definitely attenuated any and all negative effects of withdrawal. I think the only reason I'm unhappy is because I miss the positive effects of heroin.

 

[ktx49]

yea i just started bupe induction friday(yesterday)....i havent had to redose as of yet since i took my first dose yesterday evening(12mg suboxone sublingually)....i feel pretty normal....actually a TAD fucked up/sedated, basically how i feel when i wake up from a night of taking a decent amount of oxycodone(for me around 60mg)....so im comfortable with no noticeable withdrawl symptoms, but im definately not in a state of euphoric warmth.....

BTW, doesn't my bupe dose seem VERY high for the kind of oxy habit i had?!? i mean i would only take about 50mg of oxy to catch a buzz, but would usually dose between 50-80mg...orally....yet it took me 1 and half 8mg suboxone(so 12mg of bupe total)to "stabilize"????

 

[diacetyldeath]

With that habit, I would have just ridden out withdrawals and not gone for bupe.

I kicked cold turkey with the following habits:

2-3 bags heroin/day insufflated
5 bags/day heroin insufflated
8 bags/day heroin insuffalted
10 bags/day heroin insufflated

Then, I tried to quit with 10 bags/day heroin IV, and the withdrawals were too much, thus the buprenorphine.

Yes, your dose seems high, and if I were in your situation, I would seriously weigh your two alternatives: Suffering with the sniffles/insomnia/anxiety/restlessness for 4-6 days or sporting a bupe habit for years.

Remember, the half life of oxycodone is much shorter than buprenorphine or methadone. Acute withdrawal on oxycodone (or morphine, or heroin) will last 7-10 days. Acute withdrawal on a longer half-life opioid (buprenorphine, methadone) will last 24-31 days.

Don't travel this road unless you're 100% positive you want to, and you have all the facts.

I'm not saying any of this to be an ass or to disagree with your choices, rather to simply make you aware of the alternatives and the characteristics of the choices available to you.

Good luck, and be safe.

 

[ktx49]

^yea man, thanks for looking out.....
i contemplated that ALOT....i knew i could handle the withdrawls from my habit, but at the same time, my habit was growing RAPIDLY and getting out of control....i nearly stopped smoking buds because i lost interest in it due to the much preffered high....i also did not have will power to stop opiates completely, and i knew that the next time some oxycontins came around, i'd be all over them....and within a week, i'd be taking another 10-20mgs on top of my usual 60-80mg....then the cycle continues....i just know too well to kid myself about stopping opiates cold turkey!

so in laymans terms, i went on bupe for harm reduction rather than easing withdrawls....BUT, because my habit is not so bad yet, i am pretty sure that within a week or two(even my doctor said this was possible), i can start tapering....which is why i am worried about the high doseage of bupe that was needed to hold me.....maybe my habit was worse than i thought!?

also, you must remember that withdrawls are different for everyone....your habit may be worse, but i could be suffering equally bad withdrawls...now im not an idiot, so i know my habit/WDs won't touch a 10bag a day IV heroin habit, but i have been abusing opiates for about 2 years now pretty consistently....and i'd say the last 4-5 months have been daily use....put it this way, i was getting WAY worse withdrawl symptoms than sniffles/insomnia/anxiety/restlessness....it was more like complete loss of appetite/sore glands/sniffles/insomnia/anxiety/severe depression/body and joint pains/stomach pain/diarrhea/hot and cold sweats/etc.

so i do NOT intend to stay on bupe for more than 3 months, and financially, it would be a huge strain to continue any longer than that. plus, my doctor seems to be wayyyyy more interested in getting me off the drugs, than to make $$$$ from keeping me on bupe....she asked me multiple times if i was sure i couldn't do this without the bupe...i told her i could, but that i'd probally end up just scoring some more pills the next friday night that i was bored...

in all, i appreciate your concern and awareness....i am keeping my fingers crossed that i can do the bupe maint. properly and end up opiate free for a good while...

but for anyone else who reads this, is 12mg of bupe alot for someone with a oxy habit of about 60mg?? i dosed my first Sube dose(8mg) yesterday @ 5:00pm.....i waited about 4 and half hours and took another 4mg because my withdrawls were still slightly noticeable....after about 1.5-2 hours, all WD symptoms were gone, but i was not "high" per say....so basically my first dose required 12mg to hold off withdrawls....

its nearly time to take my bupe today, so how much should i take? 12mg again?? or is it not unusual to have a higher than necesary dose during induction(i thought i read this somewhere, but a quick search of the boards leaves me a little confused as almost all docs/clinics do it differently)??

thanks guys
-ktx49

 

[diacetyldeath]

so i do NOT intend to stay on bupe for more than 3 months, and financially, it would be a huge strain to continue any longer than that. plus, my doctor seems to be wayyyyy more interested in getting me off the drugs, than to make $$$$ from keeping me on bupe....she asked me multiple times if i was sure i couldn't do this without the bupe...i told her i could, but that i'd probally end up just scoring some more pills the next friday night that i was bored...

in all, i appreciate your concern and awareness....i am keeping my fingers crossed that i can do the bupe maint. properly and end up opiate free for a good while...

but for anyone else who reads this, is 12mg of bupe alot for someone with a oxy habit of about 60mg?? i dosed my first Sube dose(8mg) yesterday @ 5:00pm.....i waited about 4 and half hours and took another 4mg because my withdrawls were still slightly noticeable....after about 1.5-2 hours, all WD symptoms were gone, but i was not "high" per say....so basically my first dose required 12mg to hold off withdrawls....

its nearly time to take my bupe today, so how much should i take? 12mg again?? or is it not unusual to have a higher than necesary dose during induction(i thought i read this somewhere, but a quick search of the boards leaves me a little confused as almost all docs/clinics do it differently)??

It is a high dose for your habit. But, induction doses tend to be higher than maintenance doses. You reached your goal of staving off withdrawal -- if you are comfortable and have reached a state in which you do not crave opiates (or so they say), that's your maintenance dose. During maintenance, you can either maintain, or reduce that dose depending on your goals and the results of doing so.

If you want to get off bupe in 3 months (which is a relatively short term, considering the half life of this opioid), I would do what your body tells you. Take the 8mg for sure, and see if it holds you. Buprenorphine can take 36 hours to eliminate fully, so it may be that you need to dose 8mg one day and 12mg the next (then 8, then 12, then 8, etc.). Or, maybe you need 12mg again today.

Take the opportunity to taper whenever you can without becoming too uncomfortable.

And don't try to "kick" at 1mg -- Keep tapering. I've heard horror stories from people trying to kick from 1mg doses. Don't taper too quickly -- make sure you're stable at a dose before you reduce it again (especially considering buprenorphine's half life).

When you're down to 0.25 - 0.5mg/day for 7-14 days, it might be time to start alternate-day dosing (0.25-0.5mg every other day) and then every three days, and then you're off.

Good luck. Let us know how it goes.

 

[diacetyldeath]

Re: Re: Buprenorphine "Ceiling effect," Heroin, Methadone, and you

1. about 3/4 gram - 1 gram a day iv tan powder

2. waited til wd kicked in, about 24 hours. 16mg/2 8mg pills

3. 24mg/3 8mg pills a day

4. yes, it was amazing how much it got rid of the wd and/or want to do dope

5. no, doc never even mentioned it but did mention how much more he likes bupe than methadone

Did you ever "slip up" and try dope again? Were the results total bullshit because bupe sticks to the receptors so much better than dope, or did you get something out of it? How long did you wait after your last bupe dose before trying?

Are you still on the bupe? Going to maintain forever, or try a taper? Good luck, glad to hear it works for you.

 

[ItchySkratchy]

didn't read too much of the thread, BUT:

-Been on Suboxone maint. for 4 months.......

-supposed to be on 24mg/day, which I was for about 2 months, but I tapered myself down to 16mg/day (with NO negative WD symptoms)

-was doing 1gram (give or take) IV heroin/day....

-What's interestin, is that I feel the EXACT SAME off of 16mg's of bupe as I did off of 24........

Which leads me to believe that there may be a ceiling effect; Above certain dosages (depending on the individual obviously), more Bupe may prove to be useless....

This is just my theory.....anyone else agree?????

 

[diacetyldeath]

Re: Re: Re: Re: Buprenorphine "Ceiling effect," Heroin, Methadone, and you

yea in the end (where im at now) i had a few cravings so i went and picked up..couple the shitty dope with the fact the bupe does block better than the heroin can stimulate and now i dont really have the craving anymore cause i know i cant do anything about it. when i tried the first time it was like less than 24 hours (maybe 18 ) and then after that i stopped for 48 hours and felt the tinyest high..like i was trying to figure out if it was really there.

currently on bupe at 1/2 to a quarter pill every two days. im trying to get off its just the insomnia kicks my ass but i got a doc appt comming up so im gonna see what he can do for me...i would have stopped earlier this month if i coulda slept

Wow -- you are taking 2-4mg buprenorphine every OTHER day, and when you tried dope 48 hours after your last dose, you didn't get high? That scares the shit out of me. Either the dope was REALLY shitty, or buprenorphine does something very bad to your opiate receptors.

I just started bupe two days ago. I inducted as the withdrawal worsened, 1mg at a time, until I hit 8mg, then went to sleep. The following day I dosed 20mg by about 1 or 2PM.

Then, I fell off the fucking wagon -- imagine, a whole day and 13 hours clean! -- and did 3 bags about 4 hours after my last dose. I definitely felt it. Then I did 4 bags four hours later. Didn't really feel it. Then I slept. This morning (err, this afternoon, it was a late night), I guess 19 hours after my last H dose, I did my last 3 bags and sort of felt it. I'm going back on bupe as soon as I start hurting today, or before I go to bed, whichever is sooner.

Anyway, I think the reason I felt the heroin is because I wasn't on bupe very long. I don't imagine I'll do this again, since by the time I take bupe another few days, I definitely won't feel dope.

But wtf? You're on 2-4mg every OTHER day and you waited 48 hours after your last dose and you STILL couldn't feel it... That scares me to death, because my plan is someday to reacquire this insidious habit when it will not financially ruin me. I want to make sure it's still fun to do.

Anyone familiar with what might be causing this phenomenon? Is it because long term bupe stays in the body for upwards of 72 hours sometimes? Even so, 2-4mg seems like it wouldn't occupy all receptors... I don't know.

 

[diacetyldeath]

didn't read too much of the thread, BUT:

-Been on Suboxone maint. for 4 months.......

-supposed to be on 24mg/day, which I was for about 2 months, but I tapered myself down to 16mg/day (with NO negative WD symptoms)

-was doing 1gram (give or take) IV heroin/day....

-What's interestin, is that I feel the EXACT SAME off of 16mg's of bupe as I did off of 24........

Which leads me to believe that there may be a ceiling effect; Above certain dosages (depending on the individual obviously), more Bupe may prove to be useless....

This is just my theory.....anyone else agree?????

It's actually not a theory, it's part of the clinical guidelines for buprenorphine. Being a partial agonist at mu, its effect does not scale linearly with dose after a certain point, and that point is 16mg. For some patients, they can feel more at 24mg, and even more at 32mg, but the relationship is NOT such that the effects at 32mg are double those at 16mg -- far from it. Some patients do not feel anything different above 16mg.

The partial agonist characteristic also ensures that dumb people will have a hard time ODing on buprenorphine, since respiratory depression also occurs as a result of mu agonist activity. But since buprenorphine is very unlikely to reach the level of activity that will cause fatal respiratory depression, it's "Safer." So the partial agonist nature is a feature, not a bug -- or so we're told.

It also has the effect, or LACK of effect (in opiate-dependent or opiate-tolerant individuals) of euphoria. Another reason it's CIII instead of CII. So us dopeheads don't get any kind of buzz or high off of buprenorphine (well, most of us don't, some people report a buzz in the morning when they dose).

Personally, I have absolutely no desire to stop doing this drug, but it is ruining my finances, so I am going to take a break. Maybe someday I can move to a country in which there is a city that allows registered heroin addicts to procure pharmaceutical heroin from the government or from a clinic. Unlike most of society, I have no problem with the notion of "better living through chemistry," and if my mood without H is 5 on a scale of 1 to 10, and my mood with H is 8 on a scale of 1 to 10, and there are no negative physiological side effects (there aren't, as long as one doesn't OD), then WHY NOT?

Sorry to go off-topic. Carry on.

 

[ItchySkratchy]

Re: Re: Re: Re: Re: Buprenorphine "Ceiling effect," Heroin, Methadone, and you

Either the dope was REALLY shitty, or buprenorphine does something very bad to your opiate receptors.

I

Jeez I hope not.....being clean for this long has been good for me, but I'm not gonna lie......I DO plan on using some opiates when I get off of suboxone (hopefully just a few OC's or something.....don't wanna go back to junkie status......I know, easier said than done... )

BUT, is it true that opiate receptors can become de-sensetized from long-term methadone or bupe maintenance???? I would think not, considering heroin, oxycodone and the other commonly abused drugs don't....

I've actually heard from a couple people here at BL that bupe can, in a sense, make your tolerance LOWER when you get off of it, after long-term maintenence.....

I dunno, we'll see.....