Combination of Suboxone + Oxycodone

[AliceF]

Combination of Subutex + Oxycodone

I am desperately searching for answers at this point. My mother is nearly 60 years old and has severe COPD. She takes Oxycodone for pain relief but she is about a week short of "making it" every month. I'm not sure getting more medicine would even help her as she has an addict personality and takes them when she shouldn't, but the doctors won't prescribe her anymore because she's at the "max".

When she runs out of the oxycodone, she takes subutex for about a week and feels great.

The problem comes when she gets back on the oxycodone. She is great for a while, but then she gets horrible sick. Fever, chills, vomiting, can't breath well (copd), pain. It's a terrible sickness, she can't even get out of bed. I'm afraid she's going to die like this.

The crazy thing is that it's about 5 days after she starts taking her medicine that she starts getting sick.

But it happens every single month at the exact same time and in the exact same time of sickness so I know it has to be related to the pills.

I would be so grateful for any input on this. This isn't a question we can ask doctors and I'm really scared what might be causing this.

EDIT : She takes Subutex, I'm sorry, not Suboxone

 

[szuko000]

Welcome to bluelight!

This is kind of a tricky question and perhaps it is something you should inform the doctor of, we are not professionals and though our collective experience can help it is not your doctors advice. People can mean well but still having no idea who you are give advise that worked for them but not for you (or your mother.) Can you inform us of the dosage of both the oxycodone and the suboxone? It makes it more difficult to understand the problem without the dosage.

It could be that shes taking an extreme dose of suboxone that is not comparable to her dose of oxycodone and she experiences withdrawals on day 5 as the over all level of opiates slowly drops as the suboxone is cleared. After a few days of this dose she stabilize again and feel fine yet get no relief from the pain as her tolerance is now "maxed out?"

It would make sense that if she was taking too high of a dose of subs it would make her withdrawal because the oxycodone isnt strong enough.

*edit* This could also be precipitated withdrawal due to the oxycodone in her system and suboxone's greater binding affinity with its partial agonistic effect but that usually happens first few hours rather then 5 days in

 

[AliceF]

Welcome to bluelight!

This is kind of a tricky question and perhaps it is something you should inform the doctor of, we are not professionals and though our collective experience can help it is not your doctors advice. People can mean well but still having no idea who you are give advise that worked for them but not for you (or your mother.) Can you inform us of the dosage of both the oxycodone and the suboxone? It makes it more difficult to understand the problem without the dosage.

Thanks, we're in a very tricky situation with the doctor as he doesn't actually want much to do with her since she's become a "complicated" patient due to her COPD. I'm sure he would drop her in a heartbeat if there was any sort of indication of drug abuse. I do understand the nature of this advice though! I'm just looking for any sort of answers at this point.

She is prescribed 6x15mg oxycodone per day (90mg total), but the fact that she runs out about a week ahead of time suggests she's taking around 8-9(120mg-135mg) per day. The subutex is about 4-6mg a day. The sickness only lasts 2-3 days (usually 2).

 

[szuko000]

It the fact that it takes a while for the sickness to come on that suggests its not PW, which can happen if buprenorphine is taken too soon after your last full agonist. She should be waiting 24-36 hours before dosing the buprenorphine as it will cause discomfort, sometimes sever, if taken early.

*Also for some reason i keep thinking its the reverse but she gets sick from switching back to oxycodone so its not PW, that only happens from oxycodone to subs*

Having said that 4-6mg of buprenorphine is a large dose and my highest dose when i was an IV heroin addict was 8mg and that got me wired. I honestly think that as the subs is eliminated it causes discomfort as your mothers tolerance adjusts. 4-6mg of buprenorphine will build up and cause a rise in tolerance, which explains why your mother is comfortable on subs they are very powerful and odds are that dose gets her high (not a bad thing its caused by too much substance not a desire to get high 2 completely different things) The first thing i would do is the next time she goes to subs try titrating the dosage, so start with 1mg and take an additional 1mg every 1-2 hours until she feels normal, not good or energetic but bored and restless as normal people cant stand not doing something. It is important that she tries to find a dose that makes her feel completely normal like shes not on anything or its going to jack her tolerance up again and i really feel that at least part of this has something to do with the peaks and toughs associated with switching substances that have different binding affinities.

I really dont know though my best advise is to not switch back and forward you end up doing more harm then good. The other part of the problem is switching from full agonistic behavior to partial that has to have some effect on your body as these drugs are competing for receptor activity in a sense. If you cant get a different opiate that follows a similar profile as oxycodone, almost any other opiate would work as a full agonist, then i would try titrating the dose to a lower one with 2-3mg being the max dose for her.

Let me know how this works good luck and please remember we are not doctors and my advise is just my understanding of binding affinities and i have no direct experience in this.