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Bupe Efficiency of buprenorphine at high doses? (40mgs/day)

dhopeless

dhopeless

Bluelighter
Joined
Mar 12, 2010
Messages
154
Location
East Coast, United States
My friend takes Subutex for chronic pain. Her doctor prescribes her 5 8mg tablets a day! I think that this is extreme overkill based on my four years of experience with Subutex and all the research I have done on the pharmacology of buprenorphine. However, my friend is very stubborn about her dose and refuses to take less because she thinks if the doctor prescribed that dose, it must be right. However, in my experience, doctors, particularly sub docs have no clue what they are doing... I have read that the ceiling effect ends at 32mgs, and even that seems to be a high number. I've been on Subutex for years and do not get anymore increased effect after around 12mgs. I have also heard thatat high doses the drug starts to antagonize itself, making it less effective. Bupe is the only drug that does this that comes to mind. I know that ROA comes into play here as well. She takes them sublingually. Can anyone shed some light on this subject? This is what to confirm so I can talk to my friend and get her to stop taking such excessive and wasteful does:

1) At what dose, with sublingual ROA does buprenorphine stop producing increased effects?
2) How does tolerance come into play with the previous question?
3) Could she possibly get better pain relief if she cut her dose to say, 16mgs/day?
4) Is a doctor even supposed to be allowed to prescribe this much?

I want to get as many replies as possible so I can show this thread to my friend and get her to consider cutting down. I think it would benefit her immensely.
 
Someone else will answer the specifics, but I can tell you from personal experience (like yourself, as I was on and off bupe for years) that with bupe, less is always more. Anything above 8mg is pointless imo, and for my receptors more like 6mg, and I'm talking pure physical analgesia as well, and not holding your habit at bay.
 
I found any more than 1mg snorted/ 2mg sublingual per day was overkill. I actually was at about half of that most of the time and still had great effects.
 
for addiction treatment anything above 32mg is pointless.

and subutex is a pretty shit painkiller.
 
Even though I'm prescribed 3 a day(24 mg), I never take that much. I rarely take more than 4 mg in a day because I notice if I take a large dose like that in one day I will start getting cold chills and I really do think it starts to work against itself. And I would never wanna take it for pain relief. Theres a long list of things I would take before subutex for pain. That doctor is sooo clueless to how bupe works.
 
I took 20 mg once because I was in severe heroin withdrawal and still experiencing withdrawal on the sub. I found that taking more did not help my withdrawal sympotoms any more than the first 8 mg and actually made me feel worse because it gave me these weird hallucinations. I consider 2-4 mg sublingual to be a high dose and I would take that if i were trying to come off heroin the first day, i subsquent days i take less.
 
i agree with everyone else on this topic, when in full blown withdrawal from a nasty heroin habit i would usually only take 4 mgs and i would feel fine
if i were to take 2 mgs, most of my symptoms would be gone and if i were to cop dope, i could get high as normal usually 4-6 hours later with no negative effects from the bupe (any more than 2 mgs though and i would recieve the blocking properties)
 
I switched to bupe from being on a MMT program for quite a while (80mg daily). My bupe doctor gave me what he said was the max dose, 4x 8mg bupe daily. Well I transitioned from the meth to the bupe with NO taper, no detox or anythign like that to help, and it was pretty pain free considering all the reports you read online about having to be at 30mg. I found that to be straight up bunk information-and I will tell you why now. I took my last dose of done, used H for 4 days and nights, on the 5th I used nothing, and I stretched that out ALL the way to 30 hours. Once I hit 24 I was withdrawin pretty bad but I still made it 6 more.. I was deathly afraid of a horrid transition.

So the time comes, I cant take it anymore, I dose my bupe, and I get a little relief!!! Seriously within 8-12 days I was FULLY adjusted.. I leveled off at only 12mg bupe daily (well that is a high dose but dont forget I came straight from 80mg done). All the chills and stuff were gone after 2 weeks I was feeling blissfull. Life is SO much better being on bupe and off the clinic. Serously methadone as a drug fucking blows. It was a HUGE mistake getting on the clinic. It made my dependency on opiates SO much worse. I am releived that is over with, and I will never ever take that bullshit drug again or wait in that dumb ass line to drink strawberry cum from the bitch at the window.

Honstly if she stays taking 40mg daily of bupe thats fucking worse than 80mg methadone daily. thats just insane. seriously the transition to bupe is always horrid. You are going to have a painful few days if you have any kind of significant habit. Tell that bitch to get on the interenet and educate her self for even 30 seconds and she will soon realize she is making a big mistake that can cost a person their whole recovery. Honestly I probably would have even transitioned to less than 12mg bupe..but I had it in my head that I needed it as well. Well I tapered immediately and I am at 6mg bupe now..and life is way differetn then being on the clinic for real. I have so much more energy and happiness now. Methadone is really fucking horrible it wasted a lot of my life.
 
I think the transition was a lot easier for you because you didnt go straight to bupe after methadone. You said that you used H for 4 days and then had 30 hours clean before you took any bupe. This should have definitely made the switch easier cause the heroin wont stay on your receptors as long as the methadone will.
 
You should tell your friend that such a high dose is not necesairy, and if she wants proof bring up tamgesics , or buprinex, which were the first products to contain buprenorphine for pain reliefe. I believe the buprinex were injectable ampoules containing .3 mg, and the tamgesics were sublingual pills containing something like .2 mg of buprenorphine. It seems the only way that buprenorphine could be an effective every day painkiller is a much lower dose, as 40 mg is well above the cieling level, and not to mention, if you've take fourty mg of subutex a day, you have way more than fourty mg of buprenorphine built up in your system. Even most ignorant doctors won't prescribe above the supposed 32mg cieling.
 
Everyone seems to be on the same page here. Her doctor says that you can take higher doses for pain, but not addiction. She says that the higher doses do work better for her. Is it even possible that is true...? Is it all in her head? Thank you very much for all your input and keep it coming!
 
So do this math for me.. if methadone can give you precip withdrawals after 3 weeks according to I think it was you, and I did heroin for 4 days... why was I ok then?

by that logic methadone would have still been 'in my system' and given me precip withdrawals.
 
I don't really agree with this "less is more" (maybe you can benefit from very low doses after long maintenance at bupe and having been tapering down by small doses). However, at some point one definitely doesn't benefit anything from taking a higher dose. During the time I took buprenorphine and didehydrobuprenorphine, the ceiling was at around 30mg of buprenorphine s.l. for me. Increasing the dose from 16mg to 24mg definitely gives more effects than increasing the dose from 24mg to 36mg and in both cases it's an increase by 50%! But still, I started feeling sick when I was trying to taper down and got to 8mg, I had chills and I started sweating. And at 20-24mg I felt just fine and it even worked a little antidepressant and motivating to work which helped me a lot at university as earlier and after switching to methadone I began skipping a lot of lectures and spending more time in lab.
 
Wow...Five 8mg pills a day just for pain? That seems crazy excessive. Although this may not be the norm, I seem to fall under a similar category as Dexter. I don't really notice much in myself when taking anything over 8mg. It is usually very easy for me to taper down to a smaller amount. Lately I have been using Bupe more to stay well in in between weekend warrior sessions, but even after those it is fairly easy for me to taper down to around 2mg a day. And for me, I always notice its effects more at the smaller amounts. Perhaps because it gives the body time to get some out of your system. Dunno...

I would think it would be in her best interest to taper, if only to save some money. When I have friends who are not subutex tolerant take pieces of mine (recreationally, or for pain) they cam get by taking the tiniest slivers for full pain relief/opie euphoria...

She has to take them every day? That seems really weird for chronic pain, because eventually the body does become tolerant to it, and its pain relieving effects will become less and less apparent. Or at least this is what happens for me...

And yeah, some doctors seem to not know shit about prescribing it. For example my doctor. I feel like he's just in it for the $200 a month I have to pay his punk ass. I never go into the office, never really talk to him...just have to pay him $200 just so I can get the script. BS
 
40mg a day? And she wasn't an addict before?

I feel so sorry for her, that doctor just ruined her life. If she ever can taper down from that, the PAWS are going to be killer and last for a really long time....Why would anyone even use high dose buprenorphine for chronic pain??? What was he thinking? She needs another doctor, he is a total quack.

Her tolerance is probably so high now that no other painkiller will be effective at a dose any doctor would be willing to start her off at.

She would have been better off on 300mg of OC, or 120mg of OM, before 40mg of bupe.
 
How did you get your hands on didehydrobuprenorphine?

adder said:
I don't really agree with this "less is more" (maybe you can benefit from very low doses after long maintenance at bupe and having been tapering down by small doses). However, at some point one definitely doesn't benefit anything from taking a higher dose. During the time I took buprenorphine and didehydrobuprenorphine, the ceiling was at around 30mg of buprenorphine s.l. for me. Increasing the dose from 16mg to 24mg definitely gives more effects than increasing the dose from 24mg to 36mg and in both cases it's an increase by 50%! But still, I started feeling sick when I was trying to taper down and got to 8mg, I had chills and I started sweating. And at 20-24mg I felt just fine and it even worked a little antidepressant and motivating to work which helped me a lot at university as earlier and after switching to methadone I began skipping a lot of lectures and spending more time in lab.
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