Opioids Low dose bupe tapering % cut?

[LoveTractor]

Three questions, if you will help out with personal experience it'll be much appreciated.

When at doses below 0.2mg IN or 0.4mg S/L how much of a dose reduction have those of you who have completely tapered off found tolerable, as in causing few effects like insomnia? How frequently did you cut your dose? Where did you jump off? Please specify IN or SL doses. I'm not going the Sublocade route.

I have 80 mgs to work with and am at 0.2-mg/IN per day waterlined tablets. My technique is good. That's more than 400 days to complete the taper depending uponthe rate of cut, maybe 600 days. I think I should be finished much sooner but have no idea.

I used SR to drop pretty painlessly to zero from 3-mg IN but couldn't hack the PAWS so went back up to 0.2-mg IN. Thank you.

 

[Keif' Richards]

Hey @LoveTractor

You're at a pretty low dose right now. I assume you're going to use volumetric dosing. I'm going to also assume that you know what you're doing in that department, as you did not ask. If you need help, no problem.

This is a really difficult question for anyone to answer. I know that sucks. We can only look at the extremes and try to find some common sense somewhere in the middle. If you say your PAWS was that bad, then that's real, even if your dose is relatively low.

If you are at 0.2mg per day right now, I feel the edge of reason is about 3 months. Does that sound okay to you? I understand it is difficult. I've withdrawn from Heroin, Methadone several times and I know what PAWS is like.

You could make doses by doing something like:

0.2mg/ml

Then you would drop 0.03ml every day. So, the next day, you would administer 0.97ml. You would do those reductions each day. If you were going to prepare the solution in batches, I'd recommend doing it once a month. That is easy and convenient, but if you feel like doing it weekly, then that's obviously fine.

That would be 6mg/30ml. You can just draw up your dose each morning using a Tuberculin syringe. It's been a while honestly. I am not sure if insulin syringes still have units of that size.

I really don't think you need to stretch it out any farther. A strategy that I might recommend from experience, when you get down to the real low dose, let's say, the last 15%-20%, sit at that dose for an extra couple of weeks and reduce the rate of your withdrawal. In my experience, it is very difficult going from "something" to "nothing" regardless of the dose. It is hard to adjust to the complete absence of the Buprenorphine.

That's my recommendation.

 

[LoveTractor]

Thanks Keif! Three months is no problem to come off it, as I have far more supply than that. I agree this is a very difficult question.

Yup, volumetric dosing and water-lining with an eye dropper marked in 1/4-mLs. I will switch to a pointless insulin syringe when I need to go below 1/4-mL, which will be this week.

Thanks for the thoughts, I really appreciate it. I was surprised how much I needed to go back to 0.2-mg IN after ten days to two weeks days off SR and a full month from my last bupe dose. I get it though. SR is an agonist to some extent and although it very much reduced my tolerance / needed dose once it was gone from my system wicked insomnia hit. I can't take not sleeping for days on end so tried 1/10th of a 2-mg bupe tablet IN and slept like a baby that night and most since then. It's been a month at 0.2-mg so I think I'll drop to 0.18-mg tomorrow when I make a new solution.

I've been on MAT after a good run with IV heroin about 1/4 century ago, so MAT - mostly bupe for the past 20 years. Way too long but I’m addicted and relapsed most of the time until 2020, no issues from 2020 until 7oh came to town in 2024.

I wish MAT here (United States) were like in some countries. I would be happy to go to a pharmacy - not a clinic - for a 20-mg dose of methadone. I live too far from any clinics but 10 minutes from pharmacies.

Just a rant. With 7oh likely to be scheduled that takes away the only intoxicating opioid I'm willing to use, so this is an opportunity to fly solo and see if I can manage it. I'm too old and wise to street score anymore.

The idea to slow the very end of the taper is solid advice.

Thank you again for the quick reply.

 

[Mirage3000]

From 2 mg to zero I cut 0,2 mg every week, sublingual. That was from 5 years of 16 mg and tapering over a year in total. I did ok on this protocol... Belongs to the story that from the day I hit zero I did 3x 1 mg DSIP a day for a week.

Science on DSIP:

https://karger.com/nps/article-abstract/10/4/205/230313/Successful-Treatment-of-Withdrawal-Symptoms-with?redirectedFrom=fulltext

Use sci hub if you want to read the whole thing.