HELP a friend go from Oxycontin to Suboxone

[Em123]

Hi All


I don't really know where to post this & I am not really good "searching" here or anywhere BUT my friend has a problem & needs answers ASAP. The story is.....

She has been climbing the opiate ladder for 5 years. Started with Tram (nightmare) went the usual route from loratabs & landed with oxycodone, 30 mg pills about two and a half years ago.For at least a year she was taking 250-300 mg oxycodone. A taper was started on her own & she could get down to 120 mg but then would spike back up. She recently went to a new doctor that said he could help her taper more easily. Initially it seemed to be working, he switched her to 80 mg oxycontin twice a day with 30 mg oxycodone for "breakthrough" so the dose was a total of 260 first week (which was a significant drop..about 55 mg per day) then to 240 etc. Now when she hit 200 the w/d started & this doctor told her she wasn't really having w/d. That made her angry. She found a full bottle of 180 30 mg oxycodone & went back up to at least 300 mg a day & some days as much as 365.

Now her life is a Big Mess!

As a last ditch effort to get her life back to some degree so she doesn't lose her job & home..(.Also this friend is in her early 50's with some chronic pain issues, of course she has no real idea of what her pain level is at this point...) She wants to try sub as a detox...not the 5 day detox but the under 30 day detox with sub. Most of the doctors in NY (where she lives) don't have any open spots right now. Many more people are seeking out sub because of the new law regarding opiates. We have made many calls & there is a possibility that an opening will be available by Friday next week. We are fairly confident she can get a sub script some time next week.

Now finally the questions....

She has 3 Subutex...8 mg pills & 4 Suboxone 8 mg films..

How long should she stay off the oxycontin before switching & which should she use first the subutex or the suboxone?

There is also a good chance she can get 3 more 8 mg films is really necessary to hold her until she gets her own script.


She takes lyrcia 450mg a day & has clondidne & an anxiety med as she has an anxiety disorder that started with the switch to oxycodone. She also takes two other BP meds, norvasc & lopressor.

Can anyone help us? The last time she tried this was from Norco & she went 3 days without really bad w/d's (COWS scale). We think the lyrcia had something to do with that. Now 3 years later & heavily addicted we don't think it will be 3 days we just aren't confident the COWS scale will apply because of the other meds.

Hoping for some help.

 

[Gado]

She needs to be in moderate withdrawals before taking the Subs, I was off Oxy for 3 days before starting Subs, I'm sure you won't have to wait that long but I would recommend waiting 24-48 hours before taking the Subs, otherwise she'll go into precipitated withdrawals which is the worst thing you can ever go through.

Imagine feeling every withdrawal symptom at once, immediate sweating, pain everywhere, instant throwing up and diarrhea. She does NOT want to go through this.

It's basically because Suboxone rips any opiate still on the receptors off and takes their place. This could last anywhere from 5 minutes to several hours. Trust me when I say, WAIT UNTIL YOU'RE IN MODERATE WITHDRAWALS. She needs to hold out as long as possible.

It doesn't matter which formulation she takes Subutex or Suboxone, Subutex just doesn't have Naloxone in it which can give people headaches but its basically inactive and doesn't play much if any role in the medication so either one will work fine.

Hope everything turns out ok, and really to make the medication last you only really need to take half of the 8mg pills/strips for relief. (4mgs) actually 2mgs should provide excellent relief, it'll help make the Subs last as long as possible for her to get her own script. If you have any other questions feel free to ask.

 

[Em123]

Gado

Thank you for the info! Sucks to think about letting yourself get sick. I do have another question. Since everything got messed up for the long weekend my friend will be out of the immediate release oxycodone tomorrow but will probably have to wait until the weekend to start sub it will be a big drop without the IR oxy, can she take 3 of the 80 mg extended release OxyContin to help hold her? If she can take 3 a day how far apart should she take them? Every 5 hours or 6? She was told to take them 12 hours apart by the doctor. She doesn't get a buzz when she takes 2 a day but has no idea how or if she can take 3. Will she get buzzed from three?
that would bring intake to 240 mg so still a big drop from 300mg a day
Thanks

 

[Richie1268]

Hi Em

Taking OxyContin sustained release without taking Oxycodone immediate release will be fine.
I went from taking large amounts of both to just the sustained release with no real issues.

Good luck. Richie

 

[mrflowers00]

she may need more bupe but maybe not with an oxy addiction like that 4mg 2 to 3 times a day won't make her feel great but certainly a lot better just make sure she plans to eventually wants to get of the bupe too believe it or not people feel much better without drugs if they are addicted i just have to many health problems so i can't just quit but i'm cutting back so that's a start

 

[Em123]

Thanks Richie & Mrflowers! It really is a crappy situation to be in. She has chronic pain so who knows how this will play out. Feeling like crap, at the end of the rope is no way to be. Hoping the bupe helps get some life back so there is a desire to be clean. I am sure some of you have felt that way, just don't care about anything. I have heard mixed things about the bupe but going to take the chance to see if it helps.

Stupid question.....she is at 300 mg a day...has no more IR oxy..can she break the ER oxy or will that be a very bad thing? Sucks to be naive about this but we are.

Thanks everyone, I/we appreciate the help

 

[Tommyboy]

I don't really think that she was in withdrawal at 200mg (most people are fine taking 60% of their normal dose without feeling withdrawals) but that's irrelevant.

With suboxone, the longer you wait to start taking it the better it will work. If she can wait 36 hours it will work so much better. I understand that a lot of people won't wait that long, so 24 hours is the next best time. To help with this I suggest leaving the house where there is access to the drug for the day and try to keep it out of your mind, and when it gets really bad go home to start the suboxone.

Start with 6mg (should be equal to around 150mg of oxycodone) and then increase the dose by 2mg every 2 hours, but do not exceed 12mg. The first day is not going to be pleasant, and increasing the dose above 12mg isn't going to help any since there is a ceiling dose of buprenorphine which prevents it from working more at higher doses, so it's a waste above a certain dose. Most people report that they don't get anymore relief above 12mg, so that's why I say to stop there. If she can get away with just 6-8mg then do that. Have her wait 2 hours before deciding to increase the dose above 6mg by adding 2mg a time since it take a good hour or so to peak. The clonidine should help a lot in combination with the suboxone, so it's good she has them.

As for which to take first, I would say the subutex since there are less side effects and most people are weary of using a drug with naloxone in it during the induction phase. Again, start with 6mg, then add 2mg every 2 hours IF NEEDED and do not go above 12mg. I mean it's not a big deal to go up to 16mg, but it really won't help any and in the end you will be wishing you had that 4mg back to help with the tail end of the taper. She has to keep in mind that this drug is just to help get off the oxycodone, so it's not wise to try to take more to feel something extra from them, since that's unlikely to happen with her tolerance, and it will just make the taper more difficult.

 

[Spiffypip]

I highly recommend getting a regular subtex ( without the naltraxone pardon my spelling) prescription. In my experience any attempt at a short b-morphine taper will just end in an immediate relapse. Get a regular source so everyone can take a deep breath and look to cutting down in a couple months.

Shit sucks but if your looking for a short term cure prolong the doses as long as possible, I suggest reading mspaint adventures from the beginning. It's a lot longer than when I was detoxing.

 

[Em123]

Thanks everyone I appreciate the help!?

Can we split an 80 mg oxycontin in half so you get two 40 mg pieces to swallow

 

[Richie1268]

Hi Em123,

May I ask if your friend is in pain why you are looking at reducing the dose? Sorry if I have missed something earlier in your posts

Regarding the Oxy, as I said earlier I had both immediate release & also sustained release, taking both during the day for pain relief. I was on a hell of a high dose till the doc realised and cut me down. Totally taking out the IR and going straight onto the SR. I was afraid of having WD's not taking IR but I was fine.
I have been in the situation where I will run out so I have cut the tabs in half just to try to prevent WD. My situation now is I'm totally addicted to Oxy and not even thinking about reducing my 600mg per day till my back pain is sorted out. Waiting for an appointment to have injections which will hopefully sort my pain. Then the doc will look at tapering me gradually
The experience I have had with Oxy, I do cut them in half and crush them up before swallowing with water when i know I am running low or will run out just to try and extend the dose to reduce the time I am having WD's till I can pick up my next script.

How is your friend getting on now with everything?

Richie