Bupe Heroin habit on top of subutex habit? This should not be possible!

[thejapanfan]

Hi Bluelight,
This is my first ever forum post anywhere, so if I've broken any forum rules please accept my apologies. SWIM has been on Subutex 12mg for 6 months now. She knows all about the neurological effects of Buprenorphine and that it's high binding affinity blocks the effects of full agonists - she tried heroin once on top of the Sub and found it a total waste of time. The problem is, shortly after that she found a good source of gear that actually did do something on top of her dose of Sub. The option to skip her daily dose of Sub was not open to her, she's on supervised consumption. So For the past 3/4 months she has been smoking heroin every day on top of her Subutex. In the beginning this produced no withdrawals, she got cocky and thought she could use on top and stop whenever she wanted. Now she has found that this is far from the case. She's been trying to stop for the last few weeks and is suffering quite badly, then she ends up scoring again. To her horror she has found that even if she has a much higher dose of Subutex, like 16-18mg, it still doesn't even come close to holding her. She can't understand why this is happening, she thought the Sub blocked the heroin, but then it mustn't have done so fully, or why did she get high? She is scared that there is something else in the gear that is causing this addiction. She researched possible benzo adulterants but that seems unlikely. SWIM is also adamant that her withdrawal symptoms are not psychosomatic because she is getting physical symptoms, not just the psychological ones such as anxiety that she tends to get when merely craving. Her keyworker is talking about putting her on Suboxone, but if she has it with heroin in her system what will it do to her? The keyworker claims that the naloxone is only absorbed if the tablet is chewed, crushed or swallowed, but SWIM is not so sure. She desperately wants to get back on a level with her Sub script so she can go to university next year, but is getting to the point of feeling suicidal. Any help and advice on this matter would be much appreciated.

 

[RTrain]

Just stop doing the heroin for a few days. You will probably have minor w/d similar to a person coming off a heroin habit like yours with the assistance of subutex. Your tolerance is higher than Subutex alone can reach, since its go a ceiling effect at a certain dose (look it up its covered extensively), so taking more is not the solution, your 12 mg per day probably has you above the ceiling at all times. The difficulty to do it is similar to what a person must to do get off a decent sized heroin habit using Sub, it takes 4-5 days before you feel all right, w/ no withdrawal symptoms and thru that time it tends to get easier each day. But in your case its a bit easier because you don't have to wait to be in w/d to take the Sub, just stop the H and give it a few days. Might suck but its the quickest option, otherwise taper down the H use and it should be easier.

Also if you switch to Suboxone it won't make a difference. Its suppose to be there to stop people from shooting and snorting it, it barely absorbs under the tongue or in the GI tract.

 

[OntarioGuy]

Is methadone an option for you?it sounds like that's the maintenance drug u will need for your tolerance ...don't let the talk about methadone scare u like how the w/d is so bad....in my opinion this has been greatly exaggerated by ppl who want to keep abusing heroin etc and some i feel use it as an excuse as to why they won't get help.. at least i know ppl like this. I'm not saying everyone is like that

 

[dopemegently]

12 mgs should be well above suboxones blocking effect. In the past I've used IV morphine, diamorphine, dihydrocodeine, and street heroin while on the same dose of suboxone, and they've all had exactly zero effect; the heroin simply shouldn't be making it past the suboxone at those doses. Maybe it is an adulterant, after all?

 

[Fuzati]

And stop saying SWIM, we know it's you.

 

[Psychedelic Jay]

Wasting time and money...

 

[thejapanfan]

Thanks guys, that's about what I expected; but it's given me more confidence to get it done having some advice from people who actually know what they're talking about. Methadone is not an option now. I was on it for fourteen years, and at the end of the day it was Subutex that helped me detox then go on to achieve 18 months of total abstinence. All I can say is that this is my first and hopefully (please god!) last relapse. And I am worried it's some kind of adulterant, because if I use other gear it does nothing at all - like Psychedelic Jay says, a waste of time and money - but the other stuff really does something, unfortunately. I never thought I would end up bemoaning the strength of good tackle! And yes, all that SWIM stuff is rather silly.....but being a forum virgin I was a little over anxious not to make a tit of myself So it's get my head down for a few days, and see what happens. Thank you everybody for your advice, you have been a big help to me.

 

[dopemegently]

Well, I wish you luck getting off whatever the hell it is your taking (benzo? Speed?) The anxiety kind of sounds like benzo withdrawal I guess, but I'd say if you keep buying heroin you might as well be burning your own money up in smoke. Maybe you could invest in a urine testing kit, and see if you're showing up positive for anything? Way I see it, you need to find out what's doing this...

The only time I've ever really felt the effects of a full agonist while on suboxone, was when I was on a mere 1mg of bupe a day, and even then it wasn't the same; it was muffled somehow, and without the intense euphoria of opiates. I'd say changing from subutex to suboxone really won't solve anything here: you'd be using a much more expensive formulation of the drug, while getting pretty much the same effects. (I actually prefer subutex to suboxone and wish we still had access to it over here, we're only allowed suboxone now.)

 

[RTrain]

I wouldn't think you could break thru 12 mg a day either, you'd have to metabolize the bupe at quite the rate of speed. I metabolize is pretty quick, I'd say if I have been taking 4 mg a day, dosing it2 mg twice a day, if I just take the morning 2 mg I can probably feel h/oxy at the 8 hour mark (but def not worth it), and at 12 hours I justify using but just settle for the fact that I am either getting slight lift or need to do almost twice as much.

 

[Rob27shred]

It could go both ways as far as being cut with another active drug. Also even at a lower maintenance dose of sub say between 2 & 8mg a day the receptors should be blocked. Since it has a half life longer than 24 hrs & most dosing schedules call for 24 hrs maximum between doses you end up with a much higher level of bupe in you than the daily dosage. But I know a ton of people (including myself) that is able to get high while on suboxone/subutex. Even when I was on 8mg a day I could get high a mere 8 to 12 hrs after my daily dose of sub & take my sub on time the next day without getting PW. Although I never let it become a daily practice I never experienced any withdrawl unless I was totally dry. If I did happen to find myself in withdrawl the sub or a FA opie would take me out of it. I also don't think it's possible to have to high of a tolerance for suboxone/subutex. The ceiling dose being 36mg for subs would equal roughly 1,440mg of morphine. I don't care how high your tolerance is that would at least take you out of WD. TBPH I think your letting your mind get the best of you & that is highly exaggerating your symptoms. It's amazing how terrible you can make yourself feel once your convinced something is wrong. Good luck with stopping the FA opies & I hope it's not too bad for you.

 

[dopemegently]

I agree with that; the mind can be the ultimate head fuck when it comes to feeling ill. I remember at the start of my "drug career"-I was on 120 mgs of dhc, and when I got sick at the time it felt like agony and unbearable...of course onceI'd experienced smack WD for the first time, my light codeine WD was pleasant in comparison.

I have known people using full agonists, but they were on very low doses of bupe, and they weren't dosing daily. But 12 mgs? That's a massive dose, and when I tried it, I waited 24 hours to use "real" opiates and still I felt nothing.

IMO the great thing about bupe is I've never formed a tolerance to it-I've been on 12 mgs a day for 8 years, and have never had to increase my dose. Don't get me wrong, I don't get much of a high any more, but it's holding me as well as it ever did. Imo bupe is a great drug for opiate replacement therapy; it's practicaly custom built for that purpose.

 

[RedRum OG]

i dont know why people think its impossible to get high on 12mg+ of bupe. its absolutely not. you just have to use more and you can get as high as you would with no sub in your system. merely takes a dosage adjustment, except for drugs like codeine or hydrocodone, which are worthless to anybody with a tolerance, bupe or no

to the OP, dont swim, and you just boosted your habit/tolerance and sub is pretty weak if your habit is beyond a certain point. either just stay on strictly subs and have WD for a few days and then be fine, or get on methadone.

 

[morphonorconic]

Y'all call dope tackle?

No it's not impossible to get a high from full agonists while on buprenorphine. Bupe's receptor binding affinity is much greater than that of the abusable opioids, however even with high daily maintenance doses some quantity of a full agonist like heroin will find its way into receptors. The horrible withdrawl symptoms she's experiencing is due to her having developed a colossal tolerance even though she may not feel like she's getting high. Again this is because bupe out-competes heroin for CNS receptor sites in the brain/spinal cord. But there are also peripheral opioid receptors located throughout the body, and these too have been [constantly] saturated, especially so due to such high concentrations of pre-synaptic "overflow" of extraneous monoamines for which there is simply no room; she's essentially maxed out and all of her potential CNS affect targets are bound/taken, hence the blockade phenomenon. And although these peripheral receptors do not communicate with the CNS directly, they do interact with other signal pathways responsible for the relay of information (such as sensory input) to the brain/spinal cord. Because they are deprived of opioids, they are causing these pathways to signal pain. The extreme degree of prolonged saturation of both CNS and PNS receptors once interrupted results in profoundly intense w/d symptoms.

Taking more than 16mg of buprenorphine per day, and IMO more than 8mg is ineffective and will cause its own adverse symptoms. If she stops using heroin, she'll still have a high concentration of bupe. It will take at least a few days of discomfort to adjust to only the inverse agonist's effects, but if she continues to do what she's doing things will only get worse. Use loperamide to bridge the gap in the interim, and a benzodiazepine if possible to reduce severity. And if I'm correct, codeine is OTC in the UK, so maybe she could initially take sub-threshold waning doses to execute an improvised taper program. Best wishes,

 

[Psychedelic Jay]

For all of you that says it is possible, while I don't disagree, why waste extra money and possibly get your sub terminated?