EADD Heroin Discussion Nininininineteen [19] (I wasn't really sure what was going on)

[blondin]

FWIW the advice given is to jump to bupe at 30ml of 'done BUT you need to wit until you start to withdraw, not just a yawn or two but just before you get to the puking stage otherwise you will go in to precipitated WD's.

 

[kkattastic]

As has already been said,Methadone si for those wishing to continue using but need a stop gap if they cannot score for whatever reason.Bupe is for those that genuinely wish to quit the whole opiate thing.

 

[ScotchMist]

Ive never found myself going into withdrawls taking a subbie after using, ive done it quite a few times. Obviously Suboxone is a different matter but ive never had a problem with subutex...

 

[THECATINTHEHAT]

FWIW the advice given is to jump to bupe at 30ml of 'done BUT you need to wit until you start to withdraw, not just a yawn or two but just before you get to the puking stage otherwise you will go in to precipitated WD's.

Yup, 24 hours out from your last dose of juice is nowhere near long enough really.

Having said that I've swtiched from heroin to bupe whilst only feeling a few pretty mild shivers of wd with no problem (but it was about 18 hours from my last dose).

I wouldn't advise that though, you should wait until you're crying out for it really to ensure no risk of precipitated wd.

 

[THECATINTHEHAT]

Ive never found myself going into withdrawls taking a subbie after using, ive done it quite a few times. Obviously Suboxone is a different matter but ive never had a problem with subutex...

Suboxone is no different from subutex in this situation because the buprenorphine has a higher affinity to the receptor than the opiate you would have been using and the sublingual bioavailability of naloxone is zero anyway (although I might be wrong on that one so call me out on it if I am please). Either way the bupe will have a higher affinity than the opiate that was being used so the inclusion of naloxone has no bearing on whether you get precipitated wd or not.

 

[Shambles]

FWIW the advice given is to jump to bupe at 30ml of 'done BUT you need to wit until you start to withdraw, not just a yawn or two but just before you get to the puking stage otherwise you will go in to precipitated WD's.

I didn't quite have to wait for the puking stage but probably left it over 24h but under 36h. Uncomfortable, sweaty, crampy, agitated, not actually in screaming w/d but not exactly comfy either. I got no precipitated w/d. I'm not sure what the case is for others but both times I've been scripted bupe I was initially given a lower dose than what would be my maintenance dose and it was upped sharply over the next two days. This time out I believe I started on 4mg, 8mg the next day, 12mg the third day and that was my maintaining dose. This may have been cos my actual opi intake was a bit hazy and hard to quantify but I vaguely recall something very similar happening when I was first prescribed to replace methadone where they knew exactly what dose I'd be needing. I presume this is to minimise risk of any precipitated w/d. It did take a couple days to bed in but it was a doddle I must admit. Never actually had anything I would think of as real w/d symptoms from the first bupe dose til detox (which was a somewhat unusual detox and nobody else will ever have to do it that way - if you're asked if you'd be willing to help with a study on alternate detoxing techniques I'd suggest declining ).

 

[maxalfie]

How do they decide what dosage of bupe is right for someone?
I know when I started my meth script it was roughly 10ml for each bag you used a day.
If I was to reduce my meth script to 30ml daily then what sort of bupe dosage should I expect to be put on?

 

[Shambles]

As I recall, usual starting dose for somebody switching from the top level of methadone (30ml or thereabouts) would be 24mg of bupe. That would generally be dropped down reasonably soonish as 24mg is a bit high and it seems to interact with itself at that level which can feel a bit odd. Not exactly clucky but just not right. There seems to be a sweet spot dose which most people apparently get along best with for maintenance purposes - 12-16mg is what I've heard from both prescribing doctors and bupe scriptees as being the sweet spot. That was the kinda level I was most comfortable on. I was on 12mg this last time out but only cos I specifically asked for 12mg rather than the 16mg the doc suggested. I wasn't using huge amounts of opies so didn't want to take the piss - it's only further to taper when the time comes anyway.

As with all things it really comes down to what you discuss and decide with your doctor. They're generally quite open to suggestion and will reach compromises with people when there's a difference of opinion. That's only my own experience but seems fairly common. If you're switching from methadone it's gonna be pretty simple to know what dose you'll require cos it's standard practice. It's the fine-tuning once the change has bedded in where there's more room for manoeuvre and individual variation. It's an odd drug is bupe. Less genuinely is more much of the time - especially when it comes to doses over ~16mg where it can seem to produce some quite strange paradoxical effects sometimes. Presumably the mixed agonist/antagonist action coming into effect more - that doesn't happen at lower doses so you'll probably feel best after the initial switchover period and when you've found your own personal sweetspot. I find it pretty damn easy to taper - especially when you're still in double digits but right down till you get to the 1-2mg range really. Gets a bit trickier then for the final stage but nothing like as nasty as methadone is for those last dreg doses.

 

[maxalfie]

Thanks for that Shambles.
I have an appointment with my keyworker in a fortnight and I will ask her about it and see what she has to say as I think I have had enough now of methadone so it is time for a change.
It's hard to know if my lack of interest in everything is just the way I feel or if it is methadone that is causing me to feel this way. I've felt like this for so long that I can't recall what it is like to feel any different.

 

[THECATINTHEHAT]

How do they decide what dosage of bupe is right for someone?
I know when I started my meth script it was roughly 10ml for each bag you used a day.
If I was to reduce my meth script to 30ml daily then what sort of bupe dosage should I expect to be put on?

It's a difficult one. When I went on my juice script I was using at least 5 bags a day but up to 15 (IV), usually around the half dozen mark on working days and 8 or 9 when I wasn't. I was put on 65ml which wasn't holding me so they put me up to 80ml which didn't hold me for about a week but after that it held me for way more than 24 hours. It also had a blocking effect as I was still trying to use on top but half a gram IV was just doing fuck all so it helped me stop using on top being on such a high dose.

This time I said I was using ~1g a day IV and they went for 24mg bupe (said I definitely didn't want methadone). It doesn't quite hold me in full comfort for 24 hours but it's enough, I just have a couple of hours at the end of each 24 where I feel a bit achey and uncomfortable. Been stable on this dose for at least three months and I still get those few hours of feeling shitty every day.

 

[ScotchMist]

Suboxone is no different from subutex in this situation because the buprenorphine has a higher affinity to the receptor than the opiate you would have been using and the sublingual bioavailability of naloxone is zero anyway (although I might be wrong on that one so call me out on it if I am please). Either way the bupe will have a higher affinity than the opiate that was being used so the inclusion of naloxone has no bearing on whether you get precipitated wd or not.

Oh, my understanding of Suboxone was that it worked the same as Naltrexone. Thinking about it though you have to be clear of subbies before you start taking them so that wouldnt work would it...!

Like I say though, subs have never knocked me into withdrawls taken well before 24 hours from last use of gear..

 

[Shambles]

It's hard to know if my lack of interest in everything is just the way I feel or if it is methadone that is causing me to feel this way. I've felt like this for so long that I can't recall what it is like to feel any different.

Sounds very familiar to me. I felt exactly like that when I had stopped the gear and was on methadone alone for a couple years. Just felt blank and kinda depressed. Drank ridiculously heavily and just wasn't in the least bit happy with my situation. I was rather dubious about switching to bupe purely cos I'd never used it before and it sounded like it would be weak if you had to be down to 30-odd ml of 'done before you could take it. What made the decision for me sounds rather like your own situation - I was just sick of bloody methadone every day. I never did like the stuff and it was mostly a case of thinking I may as well give the bupe a go cos at worst I'll just end up back on methadone. Not really any way to lose out. Either things will improve or they will go back to being the same as they were before and whatever my feelings about it at least it was familiar. I was very glad I did make the change - hope that will apply to you to

 

[THECATINTHEHAT]

Oh, my understanding of Suboxone was that it worked the same as Naltrexone. Thinking about it though you have to be clear of subbies before you start taking them so that wouldnt work would it...!

Like I say though, subs have never knocked me into withdrawls taken well before 24 hours from last use of gear..

No, it's just subutex with naloxone added to supposedly stop people from IVing it, although I hear stories of people IVing it and getting fucked anyway.

If the naloxone was active sublingually then it would block the buprenorphine from the receptor because it (supposedly) has a higher affinity.

 

[5StarSquatHotel]

I remember getting switched from 40mls of meth to 8mg of subby and was told I only had to wait 24 hours, waited way longer than that and I still got thrown into intense w/d that lasted hours -scored and the gear did fuck all so had to ride it out. My advice to anyone switching to subby from meth is to fuck the methadone off for a few days before the switch and use a short acting opiate even if it has to be gear.

 

[Shambles]

I'd think you went into w/d cos 8mg of bupe is unlikely to be anywhere near enough to replace 40ml of methadone. That and 40ml of methadone is a fair bit over the maximum dose considered reasonable to switch over to bupe. Sounds like your doctors could do with checking their facts a bit better cos it appears they rather screwed you. Unwittingly I'm sure but they really ought to know the basics of what they're prescribing and if they prescribed 8mg of bupe to stand in for 40ml of methadone that is clearly not the case. 8mg of bupe would most likely block the effects of gear though - and quite likely add additional precipitated w/d I'd imagine - so not a surprise that didn't help matters.

 

[5StarSquatHotel]

This is the thing mate, they said they were going by the NICE guidelines which are not the best source of info to be honest -the NICE guidelines are created as general rules in order to keep the clients 'safe' rather than what will help most and minimise discomfort and to protect the interests of the prescriber. If you switch to a short acting opiate the week before the switch then waiting 24 hours is enough -this should be standard practise imo. On any dose of meth you should wait at least 2-3 before switching.

 

[Shambles]

I had no problems switching from meth but I tapered down below 40ml - they wouldn't even consider prescribing bupe til I got below a certain level. I don't precisely recall but 30ml sounds about right. Might have even been 25ml. 40ml is too high and will virtually guarantee precipitated w'd. Did you get your prescription from a GP rather than a DSP or other specialist drug service? GPs are not the best people to go to for drug issues usually. They tend to be kinda clueless - most won't even accept addiction cases these days. Specialist services are the way to go I'd say - they know what they're doing and are unlikely to make such baffling prescribing errors. Too much methadone and way too little bupe is quite a big mistake to make and no wonder you felt like crap. 24h is long enough - maybe 36h to be sure - to wait after last methadone dose before starting bupe. You could switch to a shorter-acting one first if really worried about it but you're probably still gonna have to wait 24h which just means you get the w/d before you start bupe instead of afterwards. Also not so wise to switch from methadone back to heroin or whatever cos we all know how much more enjoyable any opiate is than bloody methadone so it's bound to be a temptation to relapse rather than quit.

 

[THECATINTHEHAT]

I remember getting switched from 40mls of meth to 8mg of subby and was told I only had to wait 24 hours, waited way longer than that and I still got thrown into intense w/d that lasted hours -scored and the gear did fuck all so had to ride it out. My advice to anyone switching to subby from meth is to fuck the methadone off for a few days before the switch and use a short acting opiate even if it has to be gear.

Rough, you got screwed by the docs!

Should have been down to 30ml and then given 24mg bupe with the option to titrate up to the ceiling of 32mg if necessary! 8mg bupe is barely enough to cover someone smoking a couple of bags of smack a day, let alone someone on 40ml of meth!

 

[THECATINTHEHAT]

I had no problems switching from meth but I tapered down below 40ml - they wouldn't even consider prescribing bupe til I got below a certain level. I don't precisely recall but 30ml sounds about right. Might have even been 25ml. 40ml is too high and will virtually guarantee precipitated w'd.

This a little pedantic but the wd resulting from trying to transfer to bupe froom 40ml of juice would just be regular withdrawal if enough time was left, because the ceiling dose of bupe doesn't cause enough activity at the receptor to cover the amount caused by that much juice. Precipitated withdrawal is where bupe's higher affinty for the opiod receptors causes it to knock off whatever other opiod is attached and the antagonist effect (that is, it doesn't do anything) at the kappa receptor means there isn't enough total activity to cover whatever other opiod was knocked off. If you tried to swap from 40ml to any amount of bupe and only waited 24 hours it would be precipitated wd but with a load of extra regular wd on top caused by the difference in the level of activity between 40ml of meth and the celing dose of bupe. Sounds horrific.

Perhaps someone with a better knowledge of pharmacology can explain it more clearly than that.

 

[pinkpapaver]

Such a time and place thing with the addiction. At my time of getting a habit i was very undervalued lonely and unloved. When tou get them big brown hugs at a time like that . . . Say no more
Im feeling the same way right now undervalued unloved and rather than lonely unsupported.
Bring up the unsupported with my family and its a case of being unsupported because i dont deserve the support. My sons being an out and out arseholee to me and hes getting supported in this because the poor thing has been brought up by a bad junkie mom who deserves to have her house smashed up.
Same old story all the way. You can stop taking heroin when i click my fingers youre choosing not to because youre bad because youre weak and noones going to help you with anything until youve stopped completely including replacemebt therapy for at least twelve months.
The people who read this who havent a clue about the gear and want to judge go on ahead. It must be very nice to be perfect.

Anyway im lying here in bed feeling very cmforted by those big brown arms that arent going to humiliate and belittle me or rob me like any cunt out there with arms.
Im an intelligent experienced person and i know how the world works.
Bag head bad~piss head good.
Im not in denial. Im an adult and i know what works for me.