Bupe Effective Dosage Of Suboxone To Manage Cravings And Maintain a Steady Active Level?

[Doktah]

Hello fellow Bluelighters,

Continuing on with my tradition of posting every few months when I am in a shitty predicament, I come to you with this gem:

I recently (6 days ago) returned from my first rehab experience. Despite all the beliefs and negative preconceptions I had going in, I actually enjoyed my time there, and I feel that it was well worth the obscene amount of money it cost me. One of the reasons that I chose this particular treatment center was their emphasis on all aspects of addiction: Psychological, spiritual, and medical.

Anyway, while I was there a very good addiction doctor met with me numerous times and suggested that - since I have relapsed quite a few times before - I give suboxone maintenance therapy a try; he said it would most likely greatly help my cravings. Since at this point I was already clean, he started me on 2mg in the morning, which was quickly increased to 2mg twice a day.

Here is the problem: Although it worked well at first to manage my cravings, I've seemed to gain tolerance to it's therapeutic effect. When I was discharged from the rehab, I was given 2 weeks worth of carries to hold me over until I found another doctor. For the past 3 days or so, I have been elevating my dosage of suboxone on my own, and not exactly using it as prescribed either, which is 100% addict mentality.

Now, I know that suboxone will not cure my cravings (and I am fine with that), but I am wondering if it would be beneficial to increase my dose from 2mg (twice a day) to 8mg (once a day)... I'm thinking about doing this for a few reasons:

1. I've read that for maintenance, suboxone is best prescribed above it's ceiling dose (which I think is 6-8mg); that way, the degree of activity on the opiate receptors is always the same.
2. I've also read that suboxone is ideally dosed once per day, in an attempt to eradicate the mentality of waiting/thinking about next doses.

Basically, I think that I would be better off at 8mg once a day for these reasons; I think peaks and valleys of the level of the drug in my bloodstream is throwing my mood out of whack and contributing to my recent issues.

So, am I sane for reaching this conclusion?

 

[f33lg00d]

4mg once a day, the halflife is long enough for it to be stable levels. Why go backwards? If anything try to lower your dose.

 

[Doktah]

Yes, the half-life lasts slightly over 24-hours (for most people). I shouldn't have said stable blood-plasma levels... what I meant was stable level of activity at the opiate receptors.

Just for the sake of an example, let's say that the ceiling effect of buprenorphine is 4mg (so 100% activity at the Mu opioid receptors has been reached at this dose). Let's also assume that the half-life is exactly 24 hours (it's longer, but it doesn't change my point). This means that 24 hours after a dose is taken, only 50% of the drug (or whatever percentage of it was originally absorbed) remains in the blood, and therefore, the level of activity at the Mu opioid receptors corresponds to this level. Due to this decrease in activity during the 24 hour period, the person can feel the bupe's effect decreasing, and this is not good for maintenance.

Unless I am mistaken (and assuming the same ceiling dose as before), I would want to take a dose of 8mg once a day. This way, by the time I take my next dose, although the level in the bloodstream has dropped by 50%, it is still AT or ABOVE the dosage where the ceiling effect kicks in. Therefore, the Mu opioid receptors are stimulated to their maximum for the full 24 hour period, and no feeling of "diminishing effects" is felt.

Can someone please verify my logic? I have read a great deal about suboxone, and I am almost positive I am right, but I want further certainty before I call my doctor... Thank you.

EDIT: I just realized: Today I took an extra 2mg on top of my prescribed 4mg, and I noticed a significant and unmistakable increase in opioid effects. That is proof that 4mg is below the ceiling effect dose (ceiling effect would mean that I would not have felt an increase in Mu Receptor effects from the increase in dose), and therefore is not a high enough dose to maintain on without noticing changing levels of effect throughout the day.

 

[citizenuzi]

While there are some guidelines, it's going to vary based on how fucked up your receptors are. What was stable for me years ago is now... not even close. Some people metabolize sub quickly (myself included) and have a lot of difficulty feeling stable at reasonable doses. I suppose if you stay at a certain dose for long enough, FORCE yourself to deal with any side effects, you should stabilize.

Oh but really I want to say fuck whatever doctor takes somebody who is already clean and sticks them right back on. I understand the premise full well but I think it's fucking retarded and only wish I had the ability to clean up without a 6 week sub kick.

 

[stray cat]

taking the actual half-life into account, u'd likely reach the ceiling dose (using the hypothetical 6-8mgs) after a few days anyway with multi-day stacking.

 

[RTrain]

I think you may be right. I don't know if taking 1 dose a day instead of 2 is going to make much of a difference, but the larger daily dose might make a difference in terms of cravings. If nothing else, a larger dose will put in your mind the fact that you are gonna need to wait a while before you can get high of some hard stuff. Knowing that might be enough to deter you, especially if its an impulsive desire to get high.

I, for one, have always used low dose Suboxone. I try to settle into taking 2 mg 2x a day, and like to drop down from there. I have never really tried to use more than that. It seems there might be some action of the Subs that at higher doses will keep cravings down. Subs don't seem to stop my cravings very well, so I have wondered as well if a higher dose would be better to kill the continuous thoughts about getting high.

 

[Doktah]

Thanks for all the info people!

I ended up getting my dose raised to 6mg, once a day. Also, citizenuzi... I fully get where you are coming from; I was agains't maintenance before I got to treatment, and would still have rather kicked my addiction clean. However, I know fully well that had I not been prescribed the Suboxone, I would have relapsed within 3 months of leaving the facility. I'm not being a pessimist or anything of the sort, but - considering my history of use and attempts at sobriety - this was the most likely outcome. The Suboxone is currently managing my cravings (near 100%), and is thus allowing me to make all the necessary changes required to live clean and avoid future relapse - all while not having the endless cycle of finding/purchasing/consuming opiates running through my head. This for me is HUGE, as cravings made recovery for me next to impossible in the past.

What I don't necessarily agree with is using Suboxone as a detox agent (like yourself). I guess I can see the merit in cases where the full-blown withdrawals would be absolutely unbearable, but otherwise I sort of see it as prolonging the inevitable. Also, Suboxone was specifically formulated and marketed for maintenance type therapies (unlike straight bupe, which was for pain); I believe that it has tremendous therapeutic potential, in that it removes the behaviors and thoughts associated with opioid/opiate addiction while behavior is rehabilitated, and recovery is established. Although Suboxone would be useful to taper down from a high-dose opiate addiction (in a relatively short time span), using it this way completely eliminates it's main therapeutic effects. So basically, you're saying that you don't agree with an opiate-based taper protocol, because used for this purpose, that's pretty much all Suboxone is.

 

[RTrain]

^I think there is negatives to both using Subs as a short term detox tool and as a long term maintenance med. Thing is what works for one person doesn't work for another.

If you can use x-8 mg Subs to kick and do a rapid taper, then stay clean, well can't fault a person for doing that. If you would almost certainly relapse if you tried that then you can't fault someone for going the maintenance route. But with one you are at a higher risk for relapse, the other you are not really clean b/c you are still hooked on a opiate. I mean are you going to stay on it for life, its is an option, but is it one you really want to make. Maybe thats why something along the lines of a 6-8 week taper works best. Not too long, not too short.