How soon can I take subutex again after dosing with H to get over PWs?

[di_99]

I need some advice here, especially with it being Christmas Eve, going into Christmas day. I can't not feel well around my family.
I have been on subutex and/or suboxone for several years. Had to go off and on pain medication several times during that time, never had a problem with the switch. In August I was put back on pain meds during hospital stay for injured back, since then been dealing with doctors trying to decide if I need a spinal fusion. For now it's a no, but I've been having issues with pain management doctors not understanding my tolerance due to the subutex so they have had me on ridiculously low doses that did nothing, so I've been stupidly using H on top of it for relief. I'm switching back to my subutex, tried Friday night with 4 mg like I've done in the past. Had been over 24 hours, was absolutely miserable and thought I would be ok. Oh, hell no. Precipitated withdrawal like a bitch. Kept dosing more subutex by 2 mg until I was able to fall asleep after about 6 hours. The next morning (yesterday) I felt like shit but didn't know if I took more sub if it would start all over and knew I couldn't manage if it did, but had to do something to get through the holidays. Couldn't get through to any of my doctors through their answering services for advice. So I went and scored a gram. Felt better instantly, not high but normal, used the rest during the day. Woke up this morning feeling like shit again, scored another gram, did it throughout the day. Didn't get super high but did feel it. Now I'm out and with Christmas can't score anything tomorrow, and don't really want to. My question is (sorry about the long intro) when can I take subutex again? I ended up taking 12 mg Friday night, surprised I even felt the H the next day, but I assume I felt so bad because I knocked all the opiates out of my receptors. Do I have to wait 24+ hours again and feel like complete shit to start again, and risk horrendous PWs again? I was a 16 on the cows scale when I took it Friday, I assumed that was safe since in the past I've never waited past a 6. Or since I knocked all the H out of my receptors (I think) and I take the sub when I'm feeling bad but not deathly if I do go into PWs again will it not be as bad since I only have the stuff from yesterday and today in there? I hope this makes sense and I really hope someone can give me some useful advice since my doctors apparently don't want to deal with patients over the long weekend! I would wait until Tuesday morning and call their offices but this issue unfortunately won't wait until then - I'll need to make a decision one way or another by tomorrow night. You all understand how withdrawal doesn't wait until it's convenient Lol!
TIA!

 

[Pickledlemons]

Yeah I think you'll have to wait another full 24 hours. Maybe even longer to be safe. Its strange to me that you went into precip withdrawal the first time.

 

[JessFR]

Man I wish I had some good advice for you, but one solid rule I've found is that you just never know for sure what'll happen. So a best guess is probably as good as it gets. For what it's worth I know your pain. I was in Xanax withdrawal for the whole week of Christmas a couple years back. Not fun. I just drank and smoked pot a lot, helped a little.

The best advice for when you can take subuxone as you probably already know is more a question of how bad the withdrawal is than an amount of time. I don't remember what they recommend the COWS score be. I've never been on subuxone only methadone so I'm not as familiar with it by memory.

I'm inclined not to try and overthink all the "now I've taken this then but haven't taken this since x" kinda stuff and just keep it simple. Ok, subuxone causes precipitated withdrawal because it causes a sudden drop in opioid effect on your receptors. The solution is to ensure when you take the subuxone it'll be an increase in opioid activity so you feel better. Problem is there is no completely reliable way to gauge when that time is. But the best we have is to go off how much withdrawal your in.

Honestly, I hope someone with better advice than me comes along soon, and hopefully there's something I don't know cause thinking about it I'd think the best advice would be to just wait as long as you can. Preferably at least 24 hours but it depends. Depends on if there's anything else active cut with the heroin, anything else in your system, how much heroin you took and when. Which is why going by length of time is so unreliable.

How much heroin would you say is in your system as of when you last used vs when you'd last used before you got precipitated withdrawal last time. If it's the same or more you'll probably have to wait at least as long if not longer. But this is why I didn't much wanna overthink it cause it's so hard to know and so unreliable. Depends on the heroin, depends on your physiology, how much subuxone already in your system, and probably lots of other things I don't even know to think about.

Just gotta try again I guess, see if you can wait till you're a little higher on the COWS. How much you used before waiting probably makes some difference but it's probably not all that much and we know 24 hours wasn't long enough last time. But a better way to judge it would probably be to wait until you're noticeably sicker than last time. Cause again, withdrawal is a better way to judge than by time.

It's obviously not an option not, but another possibility later on is trying methadone instead of subuxone. I find methadone is a better fit for heavier users and subs a better fit for lighter users. But if subuxone a worked for you in the past then there's that to consider.

Unless I misread it you said you used a gram in a day. Now that's again not very useful since I can't translate that gram to my gram and my gram in all likelihood would be a much stronger gram. But that too I can't know for sure either. But I would call that at least a moderate habit.

I wish I could be more helpful and I hope someone else comes along soon with perhaps better advice, but this the best I can do with what I know. Good luck.

 

[di_99]

Ok, I keep trying to post this reply and it keeps getting lost. I'll check later to make sure it didn't post multiple times...

Pickledlemon - I know, I thought it was very strange too, but who the hell knows what's in H these days. Probably cut with something with a longer half life but not enough of anything to keep me from getting sick just as quick.

JessFR - I think if I could drink and smoke it would be a bit easier (although some benzos in a short duration would be ideal), but unfortunately I can't drink around my family and believe it or not, I'm allergic to weed. I was doing upwards of 2 grams a day of bmore H, which was fire, and on the days I didn't go into town I'd take my saved up pain meds, usually around 200 mg of oxy during the day and around 150 mg of morphine er to hold me during the night (prescribed 40 mg oxy and 30 mg morphine er a day, obviously a joke to me, but came in handy when I needed it). My pain doctor planned on lowering my meds next time I saw him, because he said my dose was too high to be effective, and less works better (?!?). He already had me on 1/5th of what I was on in the hospital, and every time he changed my meds he never did a conversion so I would be sick-ish for a few days. There have been more days than I can count over the past few months where I cried at the thought of having to get out of bed just to go to the bathroom I hurt so bad, but I'm finally back to semi-functional. This past week or two it's been mostly oxy and morphine days, and when I have gotten H it's been local in my country ass town, so half as good for twice as much money. I am glad that's what's in my system rather than the bmore H because I think it'll be easier to come off of, and if I think about it, nothing Fri and 2 grams of that stuff the past two days is seriously a lot less than what I've been doing. I was actually put on suboxone a few years ago as an attempt to control chronic pain, which did not work at all, but somehow it stabilized my mental health which was out of control - paranoia, hallucinations, suicidal and homicidal ideations, the works. I was committed several times and was in the psych unit at least once a month, but once I started the suboxone it all evened out, and I'm actually off all of my psych meds for now. My original H habit was over 15 years ago and I stayed clean without maintenance meds, so that's not why I was started on it. I only resorted to H recently out of pure desperation for pain relief, a sad statement about how pain doctors are being forced to operate these days. If the situation was different, I would probably consider methadone. I just need to get over this induction and I think I'll be ok again, and I'm hoping my back holds it together enough for my 800 mg motrin and flexeril to work. I think I'm being overly optimistic but I need to end this cycle I'm in now.

Thanks you guys for responding so quickly, and hopefully by morning a few more people can chime in. I guess for now I'm going to wait as long as I can stand and I'm higher on cows than 16, like Friday. I'm also going to start the subutex a lot lower than 4 mg... I can easily cut it into 2 mg, but I'll try to get it into 1 mg pieces, so if it does happen again it's not as intense. I've seen a few posts around that talk about this but no one ever posts a follow up to let people know what they ended up doing and how it worked, so I will definitely try to do that. Maybe my pain can help someone else!

Merry Christmas you guys, and thanks again!