Bupe Embeda and Suboxone

[PW2244]

I have been taking Embeda 30mg daily for chronic pain for 2.5 weeks. I want to go off the Embeda. I am trying to find out if it is safe to take Suboxone once I have gone through 24 hours of withdrawal from Embeda. Embeda contains morphine and naltrexone and Suboxone contains bup and naloxone. Just want to be sure I can safely do this. I haven't found anything on the internet to help with this. Thanks!!

 

[Hodor]

I mean, I don't see why it would be unsafe, it's just that 30mg of morphine is such a low dose that using subs to get off it would be complete overkill - given the drastic differences in potency and duration, 30 mg of oral extended-release morphine should be equivalent to between .25 and .5 mg of buprenorphine.

 

[PW2244]

First.....thank you so much for responding. I am brand new to this site and still learning. Let me explain what's going on.....even though Embeda is time released I find if I don't take it exactly 24 hours apart (let's say I go to 25 hours) I start feeling like I am going into withdrawal. When I read the insert that comes with it, it really stressed how highly addictive it is. I just don't feel good taking it. It helps my pain a little, but I feel shaky inside and just plain sick. I have Suboxone on hand, but I'm a big chicken about doing this stuff. I live alone. They make it sound like you will feel like you're dying when you go off of it. I have gone off Percocet and Ms Contin in the past using Suboxone and had no issues at all. I don't want to see my doctor because I am on disability and my copay is $45 and I don't have the money. Thanks again for your help and any other info will be greatly appreciated. Are you in the medical field by chance?

 

[PW2244]

I just sent you a long message and forgot to mention one thing. I don't know Naltrexone taken with Naloxone is dangerous. I know they are similar in that they block opiates, but I am afraid it might be unsafe to have both in my system. Thanks again!

 

[Coolwhip]

If you have been only taking opiates for a month, and are only taking 30mg of morphine per day then you won't have serious enough WD symptoms to warrant taking bupe, NOT EVEN CLOSE.(I wouldn't imagine you would have ANY except some sore muscles, insomnia, and acute depression/anxiety lasting a few days) You would have a hard time even dosing bupe without getting sick.(from its potency, not PWD)

Just quit, or ask for a smaller dose to taper with, but do not start taking bupe. Totally wrong move. And just for accuracy's sake, if the embeda is working as intended you won't have any naltrexone in your system but even if you did combining naloxone with naltrexone poses no risk.

Tbch, Hodor, you shouldn't be entertaining this idea. Especially without getting more background info which points to some unknown reason why bupe may be warranted. With what we know right now not only is it not warranted, it could both be acutely dangerous, and lead to actual dependence issues.

 

[PW2244]

Thank you, Coolwhip. I was taking MsContin 15mg for one month and then my doc switched me to Embeda. So, I have been on narcotics for 2 months and he also gave me Oxycodone 5mg. 3 times a day for breakthrough pain, but I haven't taken any for about a week. Am I still good to just stop the Embeda and will I only have a few days of feeling awful? I can deal with a few days, but not much more. Thanks again!

 

[tacodude]

Honestly at that level just go to an in patient detox that utalizes a phenobarbital regimen if you just want off. I used about half g of what I assume was 10% purity at best using 1/5 at a time IV and it was not difficult at all. A lot of it is having medical staff available to help as needed and medications on hand. Not everyone has access of course, but for your situation it sounds best.

If you use subs I recommend one big dose and if needed a couple days of microdosing, but when I looked into it and tried it that seemed to work best besides a slow ween over 2-4 weeks.

 

[Coolwhip]

I don't even think you will be feeling awful, just more uncomfortable, and probably no longer than 48 hours. Definitely won't last more than a few days. But just try going cold turkey and see how that goes, if you can't handle it then taper down, or ask for clonidine/gabapentin. Suboxone is generally for people who have been Dependant on high dose opioids for a very long time, even pain patients who have been taking heroic doses should be able to avoid switching to bupe because if they haven't been abusing their meds and can follow a prescribed regimen then they can just taper down on their DOCs. 2 months is a very short time to be taking opioids, relatively speaking. And by any measure 30mgs of extended release morphine is a minuscule dose. Suboxone is more for people who have been slamming literally 10 times that amount of heroin for a year straight. Or pain patients who are eating 300mg+ of oxycodone daily. And don't have the self control to taper on traditional opiates.

 

[Hodor]

Tbch, Hodor, you shouldn't be entertaining this idea. Especially without getting more background info which points to some unknown reason why bupe may be warranted. With what we know right now not only is it not warranted, it could both be acutely dangerous, and lead to actual dependence issues.

Yeah, sorry if I was being unclear: OP, I would strongly advise against switching to buprenorphine in your position.

As I wrote in another thread on using suboxone to get off codeine, bupe is the opioid equivalent of stabilizing a binge-drinker who chugs Everclear from the bottle into a functional alcoholic who gets through the day on a moderate 24-hour wine buzz.
30 mg of extended-release morphine, however, is only the equivalent of nursing a single bottle of beer throughout the evening.

Suboxone commonly comes in doses that are far, far more powerful than a measly 30 mg of XR morphine, and even switching to an equivalent dose (which, again, you would have to figure the different half-lives into) would be basically pointless because the suboxone is just as - if not more - recreational, since you're still far, far away from the dosage ceiling where its partial agonism starts to matter.

 

[Sertürner]

Yeah I have to agree OP. The BA of oral Morphine is very low, ~20%. So it?s only about 6mg IV Morphine daily for 2 months. You should have too much trouble quitting, especially since you have come off bupe before like you said. I would just half that dose for a week then jump off. Or maybe use a 1-3g of Kratom for 3 days or so then jump off, but I don?t even think the Kratom is nessecary.

 

[Lorne???]

^ Actually with Chronic administration it can reach 50%, albeit probably in larger doses ; stilk it should average 30-40%

OP, just cut your tablet in half for a couple days, so 15mg SR, basically like 5-7.5mg 2-3x per day

Then take a quarter of a tablet, a mere 7.5mg, you will literally be on the equivalent of ~5mg oxy, or 2.5mg IV/IM morphine, which would be like 1/8th of a mg of buprenorphine (Zubsolve or liquid solution)

A couple more days, and you can quit - Suboxone really is overboard, just to get of of 30mg of morphine, SR once per day - trust me, unless you have pain and just want to experiment with powerful, long lasting and idiosyncratic partial Mu agonist

That small dose can be simply tapered after a couple of months of using - the above method is simple and should work.

Note that you can check comfort meds, though doubt they will really be needed, except some kind of analgesic perhaps - Good Luck

 

[PW2244]

I really appreciate everyone's help. Now I am going to really confuse you all. I had been on Suboxone for 2 years. My pain management doctor put me on it trying to treat my back pain. It helped a tiny bit in the beginning. It took the edge off. But, two months ago we decided I should switch to an extended release morphine and he gave me oxycodone for breakthrough pain. I haven't taken the Oxycodone in a week. As you can probably tell, I am very new to all of this and don't understand a lot of the "lingo" I am reading here. Does the fact that I was on Suboxone affect coming off the Embeda? There are no walk-in rehab places where I live and I'm on disability and cannot afford to pay. Thanks again for helping me!

 

[PW2244]

I really appreciate the advice. Can not afford in patient detox. I am on disability and even going to my doc is $45 copay which I also can't afford every month. I also only have 3 Embeda left. I do have Clonodine and Gabapentin. I am on clonodine because my BP is high and gabapentin for nerve pain.

 

[PW2244]

Coolwhip.........I am so new to this site, so please forgive me. I don't know if half of these messages are for me or someone else. I had been on Suboxone for 2 years before going off it and on Embeda. Will the fact that I had been on Suboxone affect going off of Embeda? I'm sorry. I guess I should have mentioned the Suboxone earlier. My doc prescribes regular opiates and Suboxone. We tried to Suboxone for my pain and it took the edge off for a while, but my pain got so out of control that he switched me to Embeda and Oxycodone for breakthrough pain. I am on Clonodine twice a day for high BP in addition to my regular BP meds and I take Gabapentin for nerve pain. I am sorry for being a big baby about going off the Embeda, but in the insert that comes with it they make it sound like I will die if I go off of it suddenly. I only have 3 capsules left and I can't afford to see my doctor this month. I'm on disability. I really appreciate all the time you're taking to help me with this. It shocks me to read all of these posts. You mentioned people who are eating 300mg of Oxycodone! Wouldn't someone die taking that much?

 

[Keif' Richards]

OP, I apologize if all of this has been covered already. I didn't have time to read through all of the other posts. I will try to make this as easy to understand as possible, but the pharmacokinetics of Buprenorphine are kind of confusing, even for folks like me who are talking about them every day. You're not likely to be completely rid of the Morphine in your system for a few days, given the fact that it is controlled-release. I would definitely wait longer than 24 hours before taking Buprenorphine, as this could produce a precipitated (instantaneous upon administration) withdrawal syndrome.

Please tell me, as I'm confused, is your intent to return to your doctor soon and continue your current regimen of Morphine? If that is the case, I would definitely be against introducing Buprenorphine into this scenario. It might end up making it difficult to get back on your Morphine and I can only imagine that using Buprenorphine outside of your doctor's permission could cause you to lose your prescriptions.

Could you give me some information?

 

[PW2244]

Keif Richards.........I hope you get this since I am very new to this site. Not sure if you saw my recent post explaining that I had been on Suboxone for two years for back pain. It only took the edge off, so my doc weaned me off Sub in 4 days and started MS Contin 15mg. I was on that for one month and it did nothing for the pain so he switched me to Embeda. I am not sure if having been on Sub (8mg - 3xdaily) for that long will affect the withdrawal I will go through stopping Embeda. I only have 3 Embeda capsules left. I do plan to return to him, but I am out of money and it will not be until sometime in May. I'm on disability and it's very hard meeting the $45 copay each month. I don't like the way I feel on Emeda. Hard to explain but I feel shaky and kind spaced out from it. Also, very bad headaches. So, he will most likely put me on something else. I do understand what you are saying about the morphine being out of my system and that 24 hours is too soon.

 

[PW2244]

New to this. What does OP stand for?

 

[PW2244]

Thanks, but they are capsules not tablets. I only have 3 left.

 

[Prescottdave]

So it turns out you have been on opioids for over two years including some time previously on Buprenorphine at 24 mg a day.

Sub for a 30 mg morphine dependency is overkill. Unfortanetly being on narcotics for over two years no matter the dose will likely result in some WD symptoms.

If you go the sub route you should not dose more then 0.5 mg. I would talk to your doctor if you are serious about getting clean.

 

[PW2244]

Prescottdave, No, I was on Suboxone for two years which my doctor prescribed for back pain that I've been living with for 20 years. I have been seeing the same doctor for two years and two months. As I said, the Suboxone helped with the pain for a while but it only took the edge off. What I am asking is: Will the fact that I was on Suboxone for two years and then MSContin for a month and Embeda for 2.5 weeks bring on very bad withdrawal? PLEASE do not judge me and talk about getting clean. I have never abused drugs in my life. This site is very new to me and I am surprised at all of the posts about people who do abuse drugs, but I am not here to judge anyone. I am just trying to reach out to someone who knows much more about these drugs than I do. You try living for 20 years with 6 hernaited disks, degenerative disk disease, spinal stenosis, scoliosis and arthritis in my spine, hips, knees and hands. It's not easy, but I chose to stay away from any opiates for 18 years and I finally gave in because the pain became unbearable. This is all very new to me.