Opioids Mainly questions about switching to suboxone, ie too big of habit, etc.?

[Hobble]

I am about to try and switch to suboxone and I have a few specific questions. I didn't use the search engine for these because over the last few weeks I have already read a ton of stuff on withdrawing and suboxone, etc. and I don't recall these questions ever being answered.

First question, my habit is at about 360mg oxycodone per day. At 360mg per day I'm not really high either except for right after I dose but it does keep me mostly well for 24 hrs. No I do not take 360mg at once, that is cumulative in 3 or 4 doses throught the day and night. Is that too big of a habit for suboxone to work effectively on?

Second question. I know you have to withdraw for like at least 24 hrs before you take suboxone and I know alot of people say benzos help with withdrawls. I also know that mixing opiates and benzos is dangerous due to CNS depression. It takes about 120mg of instant release oxycodone orally to get me well for about 6 hours, if I make that my last dose of opiates how soon after taking that can I start to take benzos?

I have some Xanax and some Lorazepam. I have never taken benzos before. I intend to look up the dosages and half lifes myself because I know that question has been answered but I did want to ask if you have to let the benzos wear off fully before starting suboxone?

As a side note I did call a local suboxone doctor today because I would rather have this potential transition done under the care of a doctor but the doctor didn't call me back and I'm gonna run out of opiates very soon(like tonight or tomorrow morning most likely) and will have to do something myself if I can't get ahold of a doctor by tomorrow morning. The doctor I called was recommended by a friend so I wanted to use her but if she's not available I'll look for another. It's just that I don't have alot of time so if anyone could help by answering my questions it would be appreciated and I think the answers would also be helpful to others besides myself. I swear I have read pages and pages of threads and have not seen those specific questions answered although they probably have been.

PS I am reading the suboxone megathreads right now(like I said I have read alot of it but it's so long I know I won't be able to read it all by tomorrow morning) and I would not mind having this thread merged if a mod feels it's appropriate.

 

[mrflowers00]

well i'd say as soon as your in wds it's ok to take a modest dose of XANAX far superior to lorazepam for this purpose and i say modest because you have no tolerance and i have a bit of a larger per day oxy habit than you like 2x as much but i do it for a week at a time at the most and it takes 20mg of bupe a day for me to feel any better for the first about 5 days.

 

[Hobble]

I've been on opiates continuously for 10 months. Before that I had 30 days clean but I still wan't fully well at 30 days. Before that clean time I was on opiates for 11 months continuous. Do you think that will make a big difference compared your 1 week habits? I am just concerned that bupe won't help me at all and even if I do get a doctor they will tell me I need methadone.

Also if I may ask is that 20mg bupe per day oral or some other ROA? I reeally just want to use bupe orally because my nose feels pretty bad from snorting lots of Opana, oxy, dillies and occasionally tar heroin. Plus I have never used needles, I don't judge those who have 'cause I probably would have if I'd ever had someone to show me.

 

[mrflowers00]

i do it IV the bupe that is and if you don't like the sound of that there is always plugging (put it in an oral syringe and up your ass) to get close to the same bioavailability and it shouldn't make too huge of a difference the amount of time you've been doing it because my tolerance is still higher than yours

 

[Kid Amine]

I've been on opiates continuously for 10 months. Before that I had 30 days clean but I still wan't fully well at 30 days. Before that clean time I was on opiates for 11 months continuous. Do you think that will make a big difference compared your 1 week habits? I am just concerned that bupe won't help me at all and even if I do get a doctor they will tell me I need methadone.

Also if I may ask is that 20mg bupe per day oral or some other ROA? I reeally just want to use bupe orally because my nose feels pretty bad from snorting lots of Opana, oxy, dillies and occasionally tar heroin. Plus I have never used needles, I don't judge those who have 'cause I probably would have if I'd ever had someone to show me.

Sublingually, yes. No need to snort or plug or IV them. 20mg is a pretty high dose, the ceiling is 32mg/day. being on them continuously for 10-11 months will be a bit worse than 1-2 weeker's. I can take a quarter of an 8 (2mg) and be *okay* for 24hrs, that's despite an enormous tolerance to hydromorphone.

eta: not to come down on you, but did you *really* think you could see a doc, let alone a sub doc, on one day's notice? I hope you have alternative means, because imo it would be a miracle if you get an appt tomorrow or even Wednesday.

 

[Swimmingdancer]

Ask the doctor what she thinks about your tolerance level and if she says it might be ok, then try out the Suboxone and see if it works. You can switch to methadone later if you find that the Subxone doesn't completely eliminate your withdrawals. But I've heard of people with high opioid tolerance being fine with Suboxone. As far as I know, taking 90mg of oxycodone about every 4 hours should not mean that your tolerance is too high for Suboxone. The dosage calculators I used (and I tried a couple different ones) said that would equate to around 7 or 8mg/day of Suboxone, well below the ceiling effect.

As for the benzos, benzos are not completely contraindicated with Suboxone. If the person is tolerant to either benzos or opioids then it is considered safe to take benzos (in normal doses) with Suboxone. The benzo dosage should not be too high and you should probably try not to take a strong or high-dose benzo right before your Suboxone dose. You could always tell the doctor what you have been taking to help with your withdrawal symptoms while you waited to get on Suboxone so that she knows that info when determining how much Suboxone to give you and how to titrate your dose, that is probably the safest idea. If you are not willing to tell your doctor about the benzos then I would advise you wait until you are not feeling the effects of the benzo before taking your Suboxone, I don't think you have to wait until it is completely out of your system. Look up the duration of effects for specific benzos, the half-life does not necessarily correspond to the duration of effects.

 

[Hobble]

eta: not to come down on you, but did you *really* think you could see a doc, let alone a sub doc, on one day's notice? I hope you have alternative means, because imo it would be a miracle if you get an appt tomorrow or even Wednesday.

No offense taken. I don't really know what I thought to be honest. There is one sub doctor in my area that has ads in the paper all the time saying he will see opiate addicts on the same day they call but he charges ALOT of money. I guess the main thing is I didn't realize that some habits are too big for suboxone to work. I have access to the orange octagon 8mg subs so I was thinking worst case scenario I would withddraw with some benzos for 24 to 36hrs and then start taking the subs on my own and then get to a doctor whenever one could see me.

Thanks all for the great answers so far. I am still doing research and if anyone has more to add it would be greatly appreciated.

 

[Swimmingdancer]

In case you didn't see it, I edited my post above to add:

As far as I know, taking 90mg of oxycodone about every 4 hours should not mean that your tolerance is too high for Suboxone. The dosage calculators I used (and I tried a couple different ones) said that would equate to around 7 or 8mg/day of Suboxone, well below the ceiling effect.

But if you are going to be self-administering the Suboxone I would start with a much lower dose and gradually increase it if needed.

 

[Hobble]

In case you didn't see it, I edited my post above to add:

As far as I know, taking 90mg of oxycodone about every 4 hours should not mean that your tolerance is too high for Suboxone. The dosage calculators I used (and I tried a couple different ones) said that would equate to around 7 or 8mg/day of Suboxone, well below the ceiling effect.

But if you are going to be self-administering the Suboxone I would start with a much lower dose and gradually increase it if needed.

That's great, thank you very much. I am going to do a search on suboxone doseage calculators but if you don't mind posting links to the ones you used I would appreciate it. Some of the opioid conversion charts I've seen give widely varying results on opioid conversions so it would be helpful to know which specific suboxone dosage charts give quality information. I did check the one opioid conversion chart that I like for suboxone but it didn't have suboxone listed. No suprise since suboxone isn't a full agonist, I just didn't think to do a search for suboxone dosage calculator also.

 

[Swimmingdancer]

Sorry, on further investigation and testing of them, I have decided that the dosage calculators for bupe are highly inaccurate. Calculating the equivalent dosage for buprenorphine has some special difficulties:

A major difficulty with using dosage charts for buprenorphine is the non-linear kinetics of buprenorphine: you can't just extrapolate out with bupe, like you can with opioid agonists that don't have a "ceiling effect". Like say with a normal opioid 1mg = 10mg of another opioid, 2mg = 20mg, 3mg = 30mg etc. But with bupe maybe 1mg = 20mg, 2 mg = 30mg and 4 mg = 40 mg. Does that make sense? So I don't actually know whether or not the automated dosage calculators take this into account, and a chart that just gives a mg per mg conversion would be that accurate.

And another problem is that most such drug equivalence charts/calculators are specifically designed to show analgesic (pain relieving) equivalence and are only valid within normal recommended dosing ranges for analgesia. The equivalence values for other objectives, like euphoria or alleviating withdrawal symptoms could be different from the analgesic equivalence values. The normal dosage range for buprenorphine for analgesia in opiate naive patients is in mcgs, so 8mgs is way above the dose for normal analgesic dosing, so I can't expect the calculator to provide valid equivalence values for an 8mg buprenorphine dose.

Then your individual response to a specific drug can also vary greatly.

So you can see, even doctors have a tough time predicting how much Suboxone someone needs. What they normally do is start the person on a low dose and see whether that relieves the withdrawal, if not, give them a bit more, and so on. Which is what I recommend you do if you are going to be self-medicating.


Also one thing I just thought of, is that maybe it doesn't matter what your daily total of oxycodone is at all, just how much you take at one time in order to alleviate withdrawals. Then an equivalent dose of bupe will do the same thing but just for a much longer period of time. With that in mind, I would be really surprised if your tolerance was too high for Suboxone to work for you. I have really only heard of that happening with people who are on high doses of long-acting opioids, like methadone.

 

[Swain]

for 400mg oxy there is no way in hell you need 20mg of bupe. That is outrageous. I get by with 4mg MAX daily for a bundle a day IV NYC dope habit. WHich at the least would be like 800mg oxy prob more.

I will say though I was on methadone for a year at 80mg and switched to bupe.. I started at 12mg and was down to half that in a month.

Bupe is really strong.. but for a habit your size there is no way in hell bupe will have a problem tackling it. The worst part may just be a few days of transition.. After a real long run on full agonists the transition can be greuling but after 3 or 4 days you ahve totally adjusted.

 

[Hobble]

I'm back on this thread because I was able to get an appointment with a suboxone doctor for monday but based on what they told me I am very wary of them causing me to go into precipitated withdrawls. The person I spoke to on the phone told me to come in monday and that I would not be inducted to suboxone at that time but that I would be started on subutex and then inducted to suboxone a few days later.

When I asked her if I needed to be in withdrawls and opiate free for a minimum of 24 hours before coming in on monday she said no. So I am worried because I am pretty certain that subutex will cause precipitated withdrawls just the same as suboxone. I mean every thread I've read on here says that buprenorphine itself, which is present in both suboxone and subutex, is what causes precipitated withdrawls, not just the naloxone which is present in suboxone only. The person I spoke to on the phone seemed to think that only naloxone causes precipitated withdrawls because when I asked her about it she said "she thinks" that's why they give you subutex first but she admitted she's not very knowledgeable.

The other thing is that I have been doing pretty darn good at reducing my opiate intake these last few days. Since last friday I have only gotten high once. It's hard to calculate exactly because I was combining opiates but basicly friday, saturday, sunday, monday I went from "fun" doses of about 400mg/day down to "functional" doses of about 300mg/day. I suffered a bit but not too bad and then tuesday night I went wild but wednesday went back down to about 300mg/day. And today I am doing good by staying at about 300mg/day plus I now have a friend and confidant that tomorrow will be helping me to draw up and stick to a taper plan. It is a nonjudgmental person that I highly respect and while I can't say I won't slip I certainly can say that I won't lie about it to them. I think they will be a great aid. BTW all dosages above refer to oral oxycodone. I was taking other opiates but I converted them to their equivalent dose of oxycodone for simplicity sake.

Anyways I guess my main question is has anybody ever heard of starting on subutex without going through any withdrawls and then switching to suboxone 3 days later? I am almost certain that if I go into the doctor's office monday on opiates and they want me to take subutex right away I should say NO, NO, NO! Please confirm this as all threads I have read indicate taking any form of bupe will knock me into precipitated withdrawls. If this doctor wants to knowingly or unknowingly knock me into precipitated withdrawls I will seriously just walk out of there and go with the aforementioned taper plan.

I am thinking maybe the doctor will write me a script for subutex and tell me to go home and withdraw for 24 hours before taking it? If so, that makes sense but I just have never heard of a sub doctor writing a script for any form of bupe and letting you go home to take it for the first time.

Lastly if they do want me to take subutex in the office and I do fear precipitated withdrawls and I refuse to take it do you think they will kick me out of the program? Or might they let me come back in withdrawls if I insist I want to be in withdrawls before taking subutex?

 

[Swimmingdancer]

I think the receptionist you spoke to probably does not know very much about buprenorphine, hopefully the doctor will be more knowledgable. I really don't think that they would kick you out for being worried about the possibility of precipitated withdrawals. It is fairly common for some doctors to start you on Subutex instead of Suboxone and then switch to Suboxone after a few days, but I don't think that prevents the risk of precipitated withdrawals, since the buprenorphine itself can cause them. I assumed that they mainly just did that to see if you get any side effects from the buprenorphine before adding in the naloxone. Orally naloxone has a very low bioavailability, but a very tiny amount of the naloxone might be absorbed, so perhaps they think that could slightly contribute to withdrawals, but not having naloxone in it doesn't mean you can take Subutex whenever without any worry about going into withdrawals.

You might not need a full 24 hours free of opioids, it really does vary from person to person, but you should ideally be in full withdrawals before taking the buprenorphine. The doctor might give you a low dose first and see how it affects you, or it's possible they may just write you a prescription and tell you to start taking it the next day - it does happen as someone in another thread just mentioned that happening to them: http://www.bluelight.ru/vb/threads/630147-Suboxone-help!