Bupe Hydromorphone with buprenorphine

[chronicpainfckingsucks]

Hello everyone, this is my first time posting. I searched the forum trying to find if this topic has been posted before but I didn't find anything.

I am a male in my mid 30's that has had life long chronic medical issues. Chronic pain has been a part of my life for as long as I can remember. When I was a teenager I started using marijuana to help with the chronic pain and it was extremely effective until a few years ago.

I was hospitalized with sepsis relating to my chronic health issue and spent over a month inpatient receiving IV anti biotics and in the worst pain I could possibly imagine and was unable to even ambulate to the bathroom. I was given hydromorphone IV every 4 hours while in the hospital and following my discharge from the hospital I was referred to a pain management clinic as the sepsis really did a number on my body along with my chronic medical condition.

For the past couple years I have been prescribed 8mg hydromorphone er taken orally once a day and 2mg hydromorphone IR for breakthrough pain that I take 4x daily. This has done a great job keeping my pain well managed and under control allowing me to live as normal of a life as possible.

Recently, I was assigned a new provider who has a problem with the mme amount I'm prescribed. The provider decided to take me off of the hydromorphone 8mg extended release and put me on a buprenorphine patch that I will wear for a week at a time before replacing it. I've also been prescribed 4mg hydromorphone to be taken 3x per day for breakthrough pain.

I am concerned with the possibility of experiencing more pain than usual due to the changes in medication especially because my pain has been well managed for so long and I've had a consistent medication regimen which has worked great for me. I was wondering if anyone had any thoughts or advice they could share? Outside of medical marijuana and the pain medication I take as prescribed I do not use any drugs or drink alcohol and try to live the healthiest lifestyle possible with a great diet and exercising as much and as frequently as my body will allow. I would really appreciate any feedback on my situation and I apologize in advance if I posted in the wrong section.

 

[Direwolf131]

I cannot speak to the medications you take, I can speak to having a long term opioid working well for my pain over a decade, tramadol. I was a long time patient at a pain clinic where this medication was considered minor league, yet it worked very well for neck and shoulder disability, then the pain clinic shuttered its doors, two months notice beforehand, then handed off to the provider to do as they would, and they did, which is to say they proceeded to eliminate the tramadol altogether with absolutely no considerations for my well being whatsoever.

So my response to your inquiry is this, it could affect you negatively, certainly, all of my pain returned with a vengeance, but they took my medication away entirely, they didn't give a rats ass beyond removing me from that med and then being rid of me....

Now on the other hand you are among the very lucky few to receive anything, anything at all in way of opioid medications for your chronic pain, because a very great many others are treated exactly as I was, which is to say tapered off, then tossed to the gutter. I do hope you do well with the new dosing, but overall you are more fortunate, than not! I would be very cautious with this new "ahh" provider, because usually what they intend to do with you is exactly what they did to me.

 

[paranoid android]

Bupe wsill block the effects of the hydromorph and cause withdrawals. My friend was stupidly prescribed the bupe patch on hydro and went into full wd

 

[chronicpainfckingsucks]

I cannot speak to the medications you take, I can speak to having a long term opioid working well for my pain over a decade, tramadol. I was a long time patient at a pain clinic where this medication was considered minor league, yet it worked very well for neck and shoulder disability, then the pain clinic shuttered its doors, two months notice beforehand, then handed off to the provider to do as they would, and they did, which is to say they proceeded to eliminate the tramadol altogether with absolutely no considerations for my well being whatsoever.

So my response to your inquiry is this, it could affect you negatively, certainly, all of my pain returned with a vengeance, but they took my medication away entirely, they didn't give a rats ass beyond removing me from that med and then being rid of me....

Now on the other hand you are among the very lucky few to receive anything, anything at all in way of opioid medications for your chronic pain, because a very great many others are treated exactly as I was, which is to say tapered off, then tossed to the gutter. I do hope you do well with the new dosing, but overall you are more fortunate, than not! I would be very cautious with this new "ahh" provider, because usually what they intend to do with you is exactly what they did to me.

I'm really sorry to hear about your situation. Its crazy how in some instances providers prescribe medication excessively and others have issues with prescribing even minimal amounts. The government is way too overbearing with regulations regarding pain prescriptions.

I have monthly UA's which I've never failed, never have requested an early refill nor "misplaced" or "lost" any of my scripts. Currently I'm working on a master's degree as a full time student while working full time as well so the medications have had zero negative impacts on my life basically allows me to be comfortable at night and not wake up every 30 minutes in pain if im even able to sleep at all. I've spent over $20,000 out of pocket on physical therapy trying to improve my health in the hopes I could reduce my dosage reduce the amount of pain im in and I'm extremely pro active with my health.

It blows my mind how in medical emergencies where I've been in the ER I have still been treated very rudely simply because of the medication I am prescribed and my age even when the issue im there for isn't pain related and I never asked for or requested any pain medication. So many people have to suffer because of doctors who are more concerned with patients getting a "high" versus adequately treating their patients pain. Just really hoping this doesn't start a downward spiral as I've overcome so much already with my health issues and am doing very well in my life currently.

 

[chronicpainfckingsucks]

Bupe wsill block the effects of the hydromorph and cause withdrawals. My friend was stupidly prescribed the bupe patch on hydro and went into full wd

That is exactly what I was worried about. I asked my pain management provider if the buprenorphine would effect the efficiency of the hydromorphone and they said it would only eliminate the "high" which I don't even experience to begin with so wasn't worried about that, but I would experience more analgesic effects from taking them both. The only "high" Ive ever gotten from hydromorphone was in the hospital from the IV I was getting but I was so close to death it was not even enjoyable. Sucks going from a great provider who has everything under control and well managed to one that doesn't care and just wants to experiment with different options just to lower the mme for their records even if pain increases. I would maybe understand in different circumstances if there was an issue. Its not my place to judge but I overhear conversations in the clinic waiting room all the time of people who are without a doubt abusing their scripts but never have an issue getting them prescribed. Its so wild how much inconsistency there is in prescribing practices and overall biases towards opioids in the medical field.

 

[paranoid android]

That is exactly what I was worried about. I asked my pain management provider if the buprenorphine would effect the efficiency of the hydromorphone and they said it would only eliminate the "high" which I don't even experience to begin with so wasn't worried about that, but I would experience more analgesic effects from taking them both. The only "high" Ive ever gotten from hydromorphone was in the hospital from the IV I was getting but I was so close to death it was not even enjoyable. Sucks going from a great provider who has everything under control and well managed to one that doesn't care and just wants to experiment with different options just to lower the mme for their records even if pain increases. I would maybe understand in different circumstances if there was an issue. Its not my place to judge but I overhear conversations in the clinic waiting room all the time of people who are without a doubt abusing their scripts but never have an issue getting them prescribed. Its so wild how much inconsistency there is in prescribing practices and overall biases towards opioids in the medical field.

Ya they sound like a moron. Bupe blocks full agonists like hydro your mu receptors dont care if you get high or not lol. And ya good luck getting high on oral hydro anyway.

Another thing to remember is that bupe unlike hydro isnt for severe pain its only for moderate pain. I was going to try bupe for my pain but i wasent going from morphine which is also for severe pain to bupe

 

[Fire&Water]

Bupre' only works as minimal analgesia
unless its a first time pain script'

then they usually double or triple it until you feel way worse than starting dosage


doctors are scared to death for you
(in place of you) that you might feel the slightest if any
euphoric pain relief

 

[Direwolf131]

I'm really sorry to hear about your situation. Its crazy how in some instances providers prescribe medication excessively and others have issues with prescribing even minimal amounts. The government is way too overbearing with regulations regarding pain prescriptions.

I have monthly UA's which I've never failed, never have requested an early refill nor "misplaced" or "lost" any of my scripts. Currently I'm working on a master's degree as a full time student while working full time as well so the medications have had zero negative impacts on my life basically allows me to be comfortable at night and not wake up every 30 minutes in pain if im even able to sleep at all. I've spent over $20,000 out of pocket on physical therapy trying to improve my health in the hopes I could reduce my dosage reduce the amount of pain im in and I'm extremely pro active with my health.

It blows my mind how in medical emergencies where I've been in the ER I have still been treated very rudely simply because of the medication I am prescribed and my age even when the issue im there for isn't pain related and I never asked for or requested any pain medication. So many people have to suffer because of doctors who are more concerned with patients getting a "high" versus adequately treating their patients pain. Just really hoping this doesn't start a downward spiral as I've overcome so much already with my health issues and am doing very well in my life currently.

I did the same, never once asked for an increase in dose, never failed a count in 11 years, blood pressure was perfect, yada yada yada. Then the doctor shuttered his clinic, and I was kicked back to primary provider, just as everyone else has been across the entire nation, and they immediately reduced my dose, just as they are doing to you, and continued doing so until "presto change-o" I am now cut off completely!

I'm shocked you even found a provider to carry on the scripts, are you absolutely certain you are not being cut, because that is just how they do it, suddenly your dose is cut, then they just keep at it until they figure their asses are covered and then they shut it off entirely....

You have to understand, those evil snobs think of you as a liability to their burgeoning portfolios, its not like in the old days, where we had decent human beings who truly cared about their patients, such doctors no longer exist, you are now solidly contained within the new paradigm, they don't give a shit about you! Consider what paranoid android is telling you about the bupe, understand??? This is how they do it, they coerce you down to either nothing, or force you onto a maintenance dose of bupe, anytime they set to cutting dosing, is a thing to pay close attention too...

 

[chronicpainfckingsucks]

I did the same, never once asked for an increase in dose, never failed a count in 11 years, blood pressure was perfect, yada yada yada. Then the doctor shuttered his clinic, and I was kicked back to primary provider, just as everyone else has been across the entire nation, and they immediately reduced my dose, just as they are doing to you, and continued doing so until "presto change-o" I am now cut off completely!

I'm shocked you even found a provider to carry on the scripts, are you absolutely certain you are not being cut, because that is just how they do it, suddenly your dose is cut, then they just keep at it until they figure their asses are covered and then they shut it off entirely....

You have to understand, those evil snobs think of you as a liability to their burgeoning portfolios, its not like in the old days, where we had decent human beings who truly cared about their patients, such doctors no longer exist, you are now solidly contained within the new paradigm, they don't give a shit about you! Consider what paranoid android is telling you about the bupe, understand??? This is how they do it, they coerce you down to either nothing, or force you onto a maintenance dose of bupe, anytime they set to cutting dosing, is a thing to pay close attention too...

I'm not as worried about getting cut off completely as I am about the buprenorphrine causing side effects such as increasing pain levels or withdrawals from the hydromorphone. I'm fairly certain that after trying the buprenorphrine for a week if it doesn't help they will discontinue it and I'll just be 4mg off from where I started and I can get by with cannabis edibles filling in the gap.

The mme from 16mg of hydromorphone per day is just at the threshold of what is considered a high dosage by the FDA so lowering it by even 4mg will give them some wiggle room.

The clinic I go to is generally pretty good and consistent but they do rotate doctors around quite a bit so every once and a while new ones come around that don't have a full understanding of individual patient medical history and want to try switching things up.

My chronic medical issue is pretty rare and misunderstood by a lot of medical professionals but luckily, if you even want to call it that, with all of the hospitalizations I've had in the last few years (12 inpatient in a 15 month period totalling just shy of 3 months admitted including time spent in the ICU) I have tons of imaging and testing on record probably enough for them to write a book and I've gone through the gauntlet of playing their game with trying different medications until it's been dialed in.

Their main concern is that if I have to have another surgery in the future my dosage would go even higher. I had a pretty extensive surgery a year ago and was prescribed 10 Mg oxycodone IR on top of the hydromorphone for post op. I ended up not needing the oxycodone once I was discharged from the hospital and gave the full bottle back to the clinic which definitely factored positively into their perception of me. I've been told by several providers I've had how proactive I am about my health so for the most part they've been very willing to work with me.

I also understand the pressure pain doctors have and everything that is at stake for them including losing their medical license and/or being criminally prosecuted for excessively prescribing controlled drugs.

Again no judgement from me, but I'm also very aware that there are many patients at the clinic who are without a doubt abusing their scripts and/or taking non prescribed illegal substances in conjunction with their pain medication but as long as they pass their UA's, and don't ask for dosage increases or call in for early refills, they get their refills monthly like clockwork so I'm fairly certain I would be one of the last people at the clinic to be completely cut off but you never know. I know some parts of the country are a lot different with how they handle pain management.

 

[pixies+]

Bupre' only works as minimal analgesia
unless its a first time pain script'

then they usually double or triple it until you feel way worse than starting dosage


doctors are scared to death for you
(in place of you) that you might feel the slightest if any
euphoric pain relief

This happened to me.

On 24mg.
I feel awwwwwful

 

[chronicpainfckingsucks]

Ya they sound like a moron. Bupe blocks full agonists like hydro your mu receptors dont care if you get high or not lol. And ya good luck getting high on oral hydro anyway.

Another thing to remember is that bupe unlike hydro isnt for severe pain its only for moderate pain. I was going to try bupe for my pain but i wasent going from morphine which is also for severe pain to bupe

I don't know too much about buprenorphrine honestly, but does it matter if there is no naloxone with the buprenorphrine? They prescribed me transdermal patches that are 7.5 micrograms per hour. I told them I don't want my teeth rotting out from taking sublingual. I've always tried to be open minded to their suggestions and work with them but will let them know if I have any adverse effects of reactions to taking it.

 

[chronicpainfckingsucks]

This happened to me.

On 24mg.
I feel awwwwwful

Hi pixies+ , do you take the sublingual or transdermal patch and is 24mg the full amount or dosage per hour? How long have you been on it? I'm sorry you feel like that right now.

 

[Fire&Water]

This happened to me.

On 24mg.
I feel awwwwwful

Im glad it helps some to stay off h
wherever that may be anymore
but it sucks for real analgesia

 

[pixies+]

Hi pixies+ , do you take the sublingual or transdermal patch and is 24mg the full amount or dosage per hour? How long have you been on it? I'm sorry you feel like that right now.

I take sublingual. And I get the dose daily.. so it’s just once a day.
It’s not for pain relief in my case though.. I just wanted to comment that the higher I was put up (due to relapses) the worse I have felt.
I’ve been on it for roughly 6 years.
The 24mg has been for the last 1.5 years.

It’s torture on my mind and body. But the drops (even 2mg) drive me wild with anxiety and the worst thoughts I’ve experienced in my life.

 

[pixies+]

Im glad it helps some to stay off h
wherever that may be anymore
but it sucks for real analgesia

Agreed.

It changed my life for the better in a big way - but I feel it’s just making me sick at this point. It’s no longer helpful, but literally driving me crazy.

 

[paranoid android]

I don't know too much about buprenorphrine honestly, but does it matter if there is no naloxone with the buprenorphrine? They prescribed me transdermal patches that are 7.5 micrograms per hour. I told them I don't want my teeth rotting out from taking sublingual. I've always tried to be open minded to their suggestions and work with them but will let them know if I have any adverse effects of reactions to taking it.

No bupe itself blocks full agonist opiates like hydro

 

[Direwolf131]

I'm not as worried about getting cut off completely as I am about the buprenorphrine causing side effects such as increasing pain levels or withdrawals from the hydromorphone. I'm fairly certain that after trying the buprenorphrine for a week if it doesn't help they will discontinue it and I'll just be 4mg off from where I started and I can get by with cannabis edibles filling in the gap.

The mme from 16mg of hydromorphone per day is just at the threshold of what is considered a high dosage by the FDA so lowering it by even 4mg will give them some wiggle room.

The clinic I go to is generally pretty good and consistent but they do rotate doctors around quite a bit so every once and a while new ones come around that don't have a full understanding of individual patient medical history and want to try switching things up.

My chronic medical issue is pretty rare and misunderstood by a lot of medical professionals but luckily, if you even want to call it that, with all of the hospitalizations I've had in the last few years (12 inpatient in a 15 month period totalling just shy of 3 months admitted including time spent in the ICU) I have tons of imaging and testing on record probably enough for them to write a book and I've gone through the gauntlet of playing their game with trying different medications until it's been dialed in.

Their main concern is that if I have to have another surgery in the future my dosage would go even higher. I had a pretty extensive surgery a year ago and was prescribed 10 Mg oxycodone IR on top of the hydromorphone for post op. I ended up not needing the oxycodone once I was discharged from the hospital and gave the full bottle back to the clinic which definitely factored positively into their perception of me. I've been told by several providers I've had how proactive I am about my health so for the most part they've been very willing to work with me.

I also understand the pressure pain doctors have and everything that is at stake for them including losing their medical license and/or being criminally prosecuted for excessively prescribing controlled drugs.

Again no judgement from me, but I'm also very aware that there are many patients at the clinic who are without a doubt abusing their scripts and/or taking non prescribed illegal substances in conjunction with their pain medication but as long as they pass their UA's, and don't ask for dosage increases or call in for early refills, they get their refills monthly like clockwork so I'm fairly certain I would be one of the last people at the clinic to be completely cut off but you never know. I know some parts of the country are a lot different with how they handle pain management.

I do believe that it becomes nearly impossible to NOT at least marginally abuse the scripts, getting ahead of yourself so to speak... The longer you are on opioid medications the more moot the abuse issue becomes, the question becomes can you make do during the in between, or learn to cut down at proper times in the month. In over a decade at my clinic, thats every two months for nearly twelve years, I talked with, or met with the two md's running the clinic for no more than 30-minutes total, almost always I met with the nurse, or PA. Most likely you will be just fine, but its been my experience over all that time, by the time they are reducing doses, they are getting ready to get rid of someone, its just how they roll, compliance has nothing to do with it, its risk exposure and liability, that is what motivates them... Good luck.

 

[Pickledlemons]

I find it weird that they start you on a patch, I thought you were supposed to be stable on bupe tablets/strips before starting the patch.

Also I find it weird that they give you bupe and dillies at the same time when the bupe is going to block the effects of the dillies.

Maybe not the smartest doctor in the world?

EDIT: Oh wait I think I may be confusing the patch with the sublocade ( The injection, taken once a month). But still, you'd think they'd start you on tablets for at least finding the right dose.

 

[deficiT]

What kind of a doctor would prescribe you bupe with hydromorphone? That doesn't even sound like it would work.

Not only does bupe only offer a low amount of analgesia, taking it when you're also taking another opioid daily, will put you into precipitated withdrawal and make you really sick. Regardless if it is alongside naloxone or not.

I would be making a giant fuss about this to the doctor if I were you.

Absolutely get a second opinion before taking any bupe. This does not sound right.

This is just my opinion and I'm not a doctor, but if I was in your shoes, I would be looking for a new provider if they insist on going this course with your medication.

 

[deficiT]

If you are needing that much hydromorphone to deal with your pain, there is no possible way that any amount of bupe will provide that much relief.

To me it sounds like they are trying to taper you off. I can't think of any other reason that they would prescribe that.

I have never heard of any doctor doing this, but again I'm not a doctor.