Bupe Buprenorphine induction by microdosing without waiting for withdrawal or triggering precipitated withdrawal

[kinkyjohn]

Hey @kinkyjohn this is actually a really helpful and well-written piece of BLiterature. Like other people have mentioned already, you're describing something known as the "Bernese Method". The need for this whole discussion is for two reasons. Precipitated Withdrawal is incredibly painful. Second, Buprenorphine is only available in a certain array of dosages.

For a very long time, Buprenorphine was prescribed in a pretty rigid manner. Most people would be started at 8mg Buprenorphine and it was pretty standard for a maintenance dose to be 24mg Buprenorphine per day, usually in 3 divided doses. We now know that there are advantages to inducting at lower dosages. We also know that 24mg Buprenorphine is often a dose that makes the medication ultimately less beneficial.

Anyway, your description of your protocol is extremely helpful for everyone here. Thanks for taking the time to do it. I recently made a sticky in BDD describing the basics of producing volumetric dosing units. This is something that would be extremely useful for a person trying to stary with extremely low doses of Buprenorphine.

I tell people to start very slow. I would start with 0.1mg and increase by 0.1mg every 30 minutes for a little while. After 2 hours, you should have a good idea of whether you're moving in the right or wrong direction. Once you know you're good and not going to experience precipitated withdrawal, you can then take higher doses of Buprenorphine until you get to your sweet spot.

Buprenorphine is at its most effective all around when the dosage is kept below 4mg Buprenorphine per day. Even 8mg Buprenorphine is still taking advantage of the drug's unique pharmacology. When you go higher than this though, you sacrifice the desired Mu agonism of the drug for peripheral Opioid receptors (the ones not associated with straight pleasure).

I know I'm double posting on my own super old thread here, but I just came back and read this again and it's a really interesting point on 4/8mg. I CANNOT stand high dose bupe .. it makes me want to do something really not very sane. I remember .. 6mg was the dose target for me which was enough to get me well no matter how insane the dose of opiates I was on. Interestingly it's under the 8mg point you mention. It's also such a low dose that you have to redose bupe every day for a few days before you can stop withdrawal free. Bupe / Full agonists are both similarly addictive but bupe won't have a withdrawal if you're on it for a short period and probably assuming you've never been on bupe longer term.

I will also say that sometimes I'd just take like 25mg and call it quits .. but that was back in the days of fent and before the constant super highs and super lows encouraged me to get a method down for managing the withdrawls. Bupe does not cover over fent withdrawal like it does H or oxy or something .. but it's better than tripping out in a K hole of pain with "cholera - the abridged version," to keep you company.