Bupe I need help with a decision of dosing my subxone of 16mg a day!

[rhun]

No, I was started on 32mg because my detox ended up being potentially life threatening and I got to spend it in the ER. But I tapered down to almost 1mg, now at 4mg due to pregnancy. As many people on OD can tell you, buprenorphine has been found most effective in lower doses (4-8mg if I'm remembering correctly). When someone is complaining of cravings, not physical discomfort, I have to wonder what else is going on.

I've done both inpatient and outpatient treatment, methadone, buprenorphine, psychiatry, group therapy, individual therapy, 12 step meetings and I've lived in sober living houses, worked with other addicts, used exercise and nutrition, herbal remedies, and the list goes on. I in no way advocate any particular treatment, I support whatever works and sometimes you gotta do a lot of what doesn't work to find out what does. But nothing short of radical change and daily recovery has kept me from relapse and spiraling back into addiction.

Buprenorphine is just not enough by itself. And when someone is falling into patterns that we as addicts often follow (the desire to do more, the compulsion to redose) it should be brought up.

And treatment isn't about bringing up past shit, though it's helpful to deal with the hurt and come to a place of closure. It's about changing how we respond to life. Just because you take out or replace the drug doesn't mean the addict and all their ways of behaving are gone. "You're going to go out into the world" and do the same shit and you'll be back at square one.

 

[96chanz]

You should start out only trying one 8mg pill a day. 16mg is too much-and too much sub can actually make you feel like crap. Like a dirty distracted type feeling in your head, with a noticeable affect on normal vision/pinning of eyes which is way too physically noticeable & uncomfortable. The more you take, the less you will actually enjoy how you are feeling. It doesn't work like normal opiates. Take it slow. Start with 8mg's a day, or even a little less. You may be pleasantly surprised.

Save those extras you have on hand for an emergency, or if and when you might not be able to get to the doctor, or the pharmacy- for some unforeseen reason, or a natural disaster that might have places closed for a month, God forbid. But a good reason to save some of what you have.

omg I'm so glad I read this. The other night I Took a whole suboxone, and within a couple hours I couldn't focus on anything for my life! it was so hard to even keep my eyes open yet i wasn't really "sleepy" it was that dirty distracted feeling. i literally couldn't see almost. I'm taking sub rn until I go to my doc monday , it's a cycle I'm just not sure what's the correct ammount. Everyone's been telling me 4mg (half of the sub) once a day though ? or should I do it twice? my tolerance is 35-60mg oxy, 45-75 mg of hydro and 100 mg of morphine at a time. I've been on them for 6 years now

 

[Erikmen]

^ Actually, I did read the posts above. Still see no reason to split doses. And just because it's been discussed doesn't mean it's been addressed.

Buprenorphine is not a magic pill that fixes everything, it's simply one piece in a puzzle with the big picture being recovery. If the OP is still having cravings at 16mg then other issues need to be addressed. The questions that need to be asked are: are you in active recovery? How are you addressing your addiction other than with bupe? What have you tried so far for your recovery and what worked/what didn't work (group counseling, 12 step, inpatient, outpatient, etc).

I can't just advocate increasing the amount of medication and the times given unless the other issues are addressed. Because the reality is bupe isn't just switching one addiction for another, there's a reason a partial agonist is used over a full agonist. There's going to be cravings and other things that come up.

Sorry to hear about your health issues OP, hope all is well. Do keep us updated.
Not sure why this was closed, if the OP requested it be closed then my apologies.

I was wondering if that amount would justify if one was trying to stop methadone.
It´s harder to quit methadone than heroin or short acting medication such as Oxys, Opana etc.
Would Subs work for a methadone withdraw? I often hear that it´s important to wait for the w/d, and only use it on the 2nd day.
Does that always apply?
When I quit opiates, suboxone wasn´t an option, reason I´m asking.
Thanks!

 

[rhun]

^ I had quit methadone 3 months prior, used an insane amount of dope/benzos/cocaine, then went to detox. Not recommended.

But yes, you can definitely go from methadone to buprenorphine. And it can be ideal for someone transitioning from long-term MMT. For best results, tapering down to 20mg methadone is definitely advised. And because of methadone's long duration, you usually have to wait at least 4 days without anything before starting bupe due to precipitated withdrawal.

 

[logriffy]

Sorry for the late reply. But I do have constant pain because of a current back issue. Herniated discs in the l4 and l5 vertabrae and a pinched nerve. I find the 4x a day 4mg is working the best for both cravings and pain. I have been recommended for surgery now for my back. But I don't know how much it will help so I am going to hold off. But I was taking 300mg-400mg of roxy a day easy. And doing 10 bags a day if I couldn't get any roxy or couldn't afford it. So the 4x a day 4mg is working wonders for me. I am seeing the prescribing doctor 1 time a week and am starting to do a drug counseling program that is one on one sessions within a couple days. But I am still confused for why I had a SEIZURE. I still can't wrap my mind around it because I have never had one or have any history of seizures in my family on both sides. But I still haven't used since October 18th and plan on keeping this way. I have a lot of support from my family as well and am busy cutting out a lot of people on my life and keeping the ones who I believe are good company. Support is key but goood support is what matters. Because people can be all supportive one day and nowhere to be found the next. But I see my psychiatrist tommorow to check in about this seizure and hopefully we get to the bottom of it!

 

[The Doc.]

No, I was started on 32mg because my detox ended up being potentially life threatening and I got to spend it in the ER. But I tapered down to almost 1mg, now at 4mg due to pregnancy. As many people on OD can tell you, buprenorphine has been found most effective in lower doses (4-8mg if I'm remembering correctly). When someone is complaining of cravings, not physical discomfort, I have to wonder what else is going on.

I've done both inpatient and outpatient treatment, methadone, buprenorphine, psychiatry, group therapy, individual therapy, 12 step meetings and I've lived in sober living houses, worked with other addicts, used exercise and nutrition, herbal remedies, and the list goes on. I in no way advocate any particular treatment, I support whatever works and sometimes you gotta do a lot of what doesn't work to find out what does. But nothing short of radical change and daily recovery has kept me from relapse and spiraling back into addiction.

Buprenorphine is just not enough by itself. And when someone is falling into patterns that we as addicts often follow (the desire to do more, the compulsion to redose) it should be brought up.

And treatment isn't about bringing up past shit, though it's helpful to deal with the hurt and come to a place of closure. It's about changing how we respond to life. Just because you take out or replace the drug doesn't mean the addict and all their ways of behaving are gone. "You're going to go out into the world" and do the same shit and you'll be back at square one.

Yea it just doesnt sound like your reading my posts I just got finished telling the OP how its more addictive to take sub multiple times a day but its up to you to find if the benefits outweigh the negatives. Then you come in and say its unnecessary that she should be dosing once a day.To me being on Suboxone is replacing one addiction for another one but it seems we have different opinions on this matter. I did the whole counsling thing too at one point and even wanted to be a drug/alcohol counsler so I'm aware of the process.

I dont believe it works for everyone I mean you've done all those treatments and yet your still addicted to Suboxone. I've gone through detox many times and done the whole support system but it never worked and like so many others I relapsed over and over. Now on Suboxone ive finally found some peace in my life and I never would have thought I would be going to med school with dreams of being a doctor. I thought i was going to die a heroin junkie. Maybe I just think of the physical aspect more but I think Some people should just be on Suboxone for life and if someone feels they should I respect that. I would love to get off subs one day but I realise the chance of relapse is huge. I also have not only mental pain but physical pain which many addicts do and Suboxone makes it so I can function but I don't go out of control with trying to get high of it. I have a herniated disc ive had my leg crushed by huge logs working forestry and have diverticulitis(very painful)

The only reason I don't relapse on heroin is Suboxone and the fact I have dreams to strive for. But the dreams wouldn't have become a reality if I didn't first gain self esteem by finally being stable.

I know low doses work better i said i take 2mgs a day split up into 4 doses each day and it works for me i dont care what anybody thinks. You take 4mgs once a day and I take 0.5mgs four times a day who's to say someone dosing once a day is better than me? I feel less constipation, less pain and side effects dosing this way plus I have no desire for doing heroin whereas taking it once a day I was using dope on top or skipping days.

All im saying is The OP has heard lots about what can go wrong with dosing like this and has made an informed decision which should be respected.

 

[rhun]

^ my post was not directed at you, it was directed to the OP. You chose to respond to my post and start this discussion. You're not the only source of information on this forum and just because you gave the OP your opinion doesn't mean the situation is addressed and no one should give further input. I think you're taking this a little personal when there's no reason to, the great thing about OD is all the difference perspectives. Now I'm going to remove myself from this discussion because I don't think it's going anywhere and it's detracting from the thread. Thanks.

 

[rhun]

Sorry for the late reply. But I do have constant pain because of a current back issue. Herniated discs in the l4 and l5 vertabrae and a pinched nerve. I find the 4x a day 4mg is working the best for both cravings and pain. I have been recommended for surgery now for my back. But I don't know how much it will help so I am going to hold off. But I was taking 300mg-400mg of roxy a day easy. And doing 10 bags a day if I couldn't get any roxy or couldn't afford it. So the 4x a day 4mg is working wonders for me. I am seeing the prescribing doctor 1 time a week and am starting to do a drug counseling program that is one on one sessions within a couple days. But I am still confused for why I had a SEIZURE. I still can't wrap my mind around it because I have never had one or have any history of seizures in my family on both sides. But I still haven't used since October 18th and plan on keeping this way. I have a lot of support from my family as well and am busy cutting out a lot of people on my life and keeping the ones who I believe are good company. Support is key but goood support is what matters. Because people can be all supportive one day and nowhere to be found the next. But I see my psychiatrist tommorow to check in about this seizure and hopefully we get to the bottom of it!

If you have legitimate pain then dosing throughout the day may very well be appropriate. I was only going off the information you provided previously.

Sounds like you're making great progress! Have you checked out Sober Living?

 

[logriffy]

If you have legitimate pain then dosing throughout the day may very well be appropriate. I was only going off the information you provided previously.

Sounds like you're making great progress! Have you checked out Sober Living?

yes I am making very good progress. And no I have not, what is this sober loving?

 

[The Doc.]

yes I am making very good progress. And no I have not, what is this sober loving?

I don't know if that was meant to be sarcastic and you meant to say sober "loving" but if not no we are not in sober living this is more harm reduction. If you want sober living you can find it here
http://www.bluelight.org/vb/forums/269-Sober-Living

That's if you want to visit the sober living section if you didn't then my bad just ignore that.

I understand what it's like to have a bad back and not just a sore back people complain about from sitting in a chair all day I mean try pain day in and day out. I wake up in pain go to work in pain and it gets tiring it wears you down big time. The Suboxone just takes enough pain away to let me function so I'm happy I found a good way to dose it. Before when taking it once daily I was in withdrawals by the evening due to my fast metabolism and all I wanted was oxys or heroin for the pain since the bupe wasnt doing anything for the pain taken that way.

Hope you keep in touch with me and Bluelight this is a great community for help.

 

[adder]

I've been taking Suboxone for 2 years now. I also quit clonazepam 11 months ago after being addicted to benzodiazepines for 9 years. I was at 8mg of Suboxone most of the time but earlier this year I tapered down to 2mg and while I felt much better at that dose, I ended up taking 4mg a day because I started taking more when I was abroad. When you take 2mg a day and then suddenly take 4mg a day, there's certainly a difference, I actually still occasionally feel a weak opioid high from 4mg taken at once (not always, I guess it could be related to my diet). Never mind that anyway... I noticed that the higher the dose, the more Suboxone was making my hands shake. Obviously my hands have been shaking because I quit benzodiazepines but Suboxone made it a bit worse too.

I can imagine that it may be related to kappa antagonism of buprenorphine. Kappa agonists are sedative and buprenorphine can even make you more anxious if you already have problems with anxiety without it. I don't really know now how exactly this may be related but I clearly noticed that the higher the dose of buprenorphine, the more my hands shook. The more buprenorphine you take, the higher buprenorphine/norbuprenorphine ratio (I mean molecules of each occupying your receptors). There's a substantial difference between qualitative effects for me of 2mg and 8mg doses where a 2mg dose is much more peaceful and not as speedy as a 8mg dose, and the morphine-like opioid effects start subsiding more or less above 4mg a day.

Low doses really work better and halving your Suboxone dose is far from being as hard as halving your heroin dose for instance. And when your tolerance decreases, you should feel better at a lower than at a higher dose. I'm not saying that I'm sure your seizure was related to your Suboxone dose but it somehow feels reasonable for me to think that it was involved. 16mg a day is a ridiculously high dose in my opinion considering that above a certain dose opioid effects hardly increase, you only make buprenorphine clearance slower and at the same time side effects increase. I know some people say they didn't feel well on lower doses of buprenorphine and 16-32mg a day helps them, but in those cases either people simply have a too high tolerance for buprenorphine to fully help them or their mental cravings are to be blamed.

 

[Erikmen]

^ I had quit methadone 3 months prior, used an insane amount of dope/benzos/cocaine, then went to detox. Not recommended.

But yes, you can definitely go from methadone to buprenorphine. And it can be ideal for someone transitioning from long-term MMT. For best results, tapering down to 20mg methadone is definitely advised. And because of methadone's long duration, you usually have to wait at least 4 days without anything before starting bupe due to precipitated withdrawal.

4 days!!
Methadone-wise this would be a hell worse than withdrawing from whatever man, including f..ing fentanyl!
Which is by the way known to be the most potent opiate. I mean even that has a milder withdraw.
Why people have to wait 4 days, why not after 24-36 hours? Is it because you cannot have a trace of opiate in your system?
Btw, coke to use when you are in w/d from h is not a good idea. When you come clean, there will be just a full emptiness ..

 

[Erikmen]

Sorry, this is just to understand this correctly.
Would it NOT work if you still have opiates in your system. Is it the reason? or convenience?
What is the real reason why you couldn´t so you can cope.
Does it absorb whatever you may still have?
I know subs are prescribed to be used when you are withdrawing. I wonder why that is.
Doesn´t it work if you do it while you have traces of opiates although it may be minor?

 

[logriffy]

Sorry haha I was not meaning to be sarcastic in anyway. I will have to check it out and I am loving this bluelight community. 16mg suboxone a day is perfect dosage for craving/pain/withdraw. Especially doing it 4mg 4 times a day. It is working wonders. I don't know if I'm ready to lower it but I don't want to get a tolerance and have to raise it.

 

[rhun]

@Erikmen methadone has such a long duration that you have to wait 4 days so you don't risk precipitated withdrawal when you dose the buprenorphine. For other opioids, you can dose bupe after 24 hours though some people are able to do it as early as 12 hours depending on metabolism and if the opioid is very short acting.

Once you're on bupe, there's no risk of PWD because of this opioid's high binding affinity to the receptors. But when first starting it, PWD can occur when the bupe kicks off the other opioid off your receptors(say methadone if that's what you're on) and then they compete, which doesn't allow either to attach to the receptor. So you're in full blown, agonizing withdrawal with no way to get relief. You just have to wait it out. (Note: this is a very, very basic explanation of PWD I was just attempting to make it easy to understand)

So to summarize, PWD is hell and something to be avoided at all costs. One dose of methadone lasts over 24 hours and that doesn't even include all the half lives... the next day you'll still have half the dose in your system (approx). For really high dose methadone patients switching to bupe their doctors sometimes make them suffer 7 days, which is why tapering is advised plus it'll make the bupe more effective. I've known really low dose methadone patients who only had to wait 72 hours but it's rare and trying to dose early isn't worth the risk of PWD.

Hope that helps a little.

 

[Erikmen]

Yes, it helped a lot!
Thank you!!

 

[The Doc.]

Sorry haha I was not meaning to be sarcastic in anyway. I will have to check it out and I am loving this bluelight community. 16mg suboxone a day is perfect dosage for craving/pain/withdraw. Especially doing it 4mg 4 times a day. It is working wonders. I don't know if I'm ready to lower it but I don't want to get a tolerance and have to raise it.

That's good stay on it for as long as you need but keep in mind the taper from 16mg to say 4mgs will be pretty much painless and once on a lower dose for a bit you'll start to feel even better.

I wouldn't worry about getting a tolerance to the sub I've taken it for 2 years and never had to raise my dose. I've known people on it for 10 years and they are still taking the exact same dose they were when they first started. Bupe doesn't work the same way as other opioids/opiates your tolerance should only get higher if you used heroin on top of the Suboxone or if you purposely take more Suboxone than usual to try to get a stronger high/pain relief. If you stick to the same dose everyday then you can be on that dose for years and years:D its a wonderful thing isn't it? thats why I love Suboxone more than others opiates.

 

[rhun]

Sorry haha I was not meaning to be sarcastic in anyway. I will have to check it out and I am loving this bluelight community. 16mg suboxone a day is perfect dosage for craving/pain/withdraw. Especially doing it 4mg 4 times a day. It is working wonders. I don't know if I'm ready to lower it but I don't want to get a tolerance and have to raise it.

Dosing bupe more frequently definitely helps with pain. Just be aware that less is more with this medication. Which can be really hard to wrap our brains around as addicts, we've conditioned ourselves to believe more = better. Which is definitely the case when using. Bupe just doesn't work that way, it's been found that people do better in the long run on 4-8mg and increasing dosage doesn't increase desired effects.

For example, when I was down to 2mg I took 32mg and felt absolutely nothing. But when I ran out of my script for a couple days once while on 4mg I took 2mg and felt a little sleepy... first time I've ever been able to tell I took my meds. But when I took another 2mg it didn't increase the effects at all. I've known many people who didn't feel their bupe till they tapered lower and recreational users usually IV a small amount, 1-2mg or less. It's a weird drug.

But sometimes you do have to start on a higher dose of bupe initially, especially if you have a high tolerance. 32mg didn't even begin to cover all my withdrawals, even after 7 days of it stacking. Just be open to tapering, I can tell you from experience it's better that way. And it's 100x harder to get off when you maintain on a high dose.

Best of luck with everything. And yeah, make a post in SL

 

[rhun]

Yes, it helped a lot!
Thank you!!

Anytime.

 

[The Doc.]

Hey erikman switching to bupe from methadone is easy if you have a doctor who knows what they are doing. Its very hard even with tapering to a low dose to go without methadone for 4-7 days but what I advise methadone patients to do when they want to switch is to first get in a short acting opiate for a week then make the switch. You could taper down to say 30mgs of done then for one week you take short acting opiate such as oxycodone until the methadone has left your receptors fully. Then once on oxycodone for a week your doctor can switch you to Suboxone and instead of waiting a few days with nothing you only have to wait 12 hours or so to take your first Suboxone dose depending on how fast your metabolism is. This way you can avoid the uncomfortable feeling of being without methadone for days while it slowly leaves your body. This greatly decreases the chances of going into precipitated withdrawal when you take your first dose of Suboxone yet the transition isn't very uncomfortable at all.

Its alot easier to go from a short acting opiate like oxycodone to Suboxone than it is to go straight from methadone to Suboxone. Going from methadone straight to Suboxone is a real pain in the ass.

As rhun said Precipitated withdrawal is when the Suboxone Rips all your opiates off the receptors leaving you sick as a dog. Its like getting hit with a shot of narcan you go from being stable/higj on opiates to being so dope sick you can't stand it anymore in only seconds. Its very uncomfortable and hard on the body to experience this. If your body isn't very strong precipitated withdrawal can kill you.