with bupe you need to be in withdrawals before you take it, to avoid precipitated withdrawals.
Is that what you mean by "used correctly"?
Buprenorphine has a really high binding affinity, but i've never heard of it being effective orally - its oral BA is ~15%
The oral route of drug administration was not pursued because substantial first-pass metabolism of buprenorphine led to limited oral bioavailability of approx 15%
(From
this article "Controlled Drug Administration Studies of High-Dose Buprenorphine in Humans").
So, while it is of course
possible that it was suboxone/subutex (ie buprenorphine) that caused this, i'm inclined to think that it's one of the least likely possibilities.
How many doses of methadone are in each take-home bottle?
Because i suspect that if bupe has a 15% bioavailability, and this is further diluted (i assume?) in a bottle with other doses - is that right?
Or does one bottle = one dose of 79mg?
The reason being, that supplies of ORT drugs - and all controlled narcotics - are very tightly regulated in any environment, especially a methadone clinic.
Supplies of surplus suboxone would not just be sitting around, and i highly doubt that any of the patients there would be easily fleeced out of their daily dose. Each one would have to be signed off on, and i imagine there are a number of systems in place to prevent theft, adulteration and so on.
If the nurse (who apparently doesn't work there any more) was caught doing shady things (like stealing, diluting or adulterating drugs) i would imagine the clinic would be obliged (ethically, if not legally) to inform you of this, following your intense, out-of-the-blue WDs.
Even if they were caught making honest (but bad) mistakes and subsequently dismissed, the clinic would have a duty of care to inform you, because an error in dosing someone could cause overdose.
And with any drug so heavily monitored, every millilitre would have to be accounted for - as would every suboxone strip.
These strips are packaged individually in a sealed package, so they're not something that a worker could dole out randomly to 'surprise'
unlucky patients.
I think suboxone is one of the
least likely culprits here.
There is no obvious answer to me as to what i think may have happened to you, but i think the likelihood of it being suboxone is pretty low.
Not impossible, but simply unlikely.
Have you ever experienced methadone withdrawals prior to this? Ever been prevented from being able to dose for a day or two somehow? I just wonder because the suddenness and intensity you describe sound really full on. But the human body is a pretty complicated thing - there are plenty of mysteries still in medicine, and especially in our understanding (and treatment of) addiction.
Sounds like a really unpleasant experience and it must be frustrating that you've not had much help in pinning down the cause of it.
Is it possible for you to request your clinic drug test you?
Bupe can stay in your system for a pretty long time, and may still be detectable if this happened to you ~4 days ago.
I suspect (through logical deduction but absolutely no evidence) that bupe is
unlikely to have found its way into your methadone - then into your system - in a high enough dose to cause precip WD.
But having a further urinalysis done at the clinic should be able to rule this in or out.
I think R13 makes some really interesting points about gastrointestinal issues that could hinder, or prevent absorption.
I'm not pretending to have any answers - just attempting to apply "Occam's razor"
