methadone, buprenorphine and other opioid pharmacotherapies

[brighton]

Its different for everyone. I started suboxone at 28. Keep us updated as to how you go You sound really motivated and have a great plan in place. I hope everything works out well for you

 

[Freaksh0w]

Been on the bupe for over 3 years now. Maybe 4? The vast majority of that was legal, going to a doctor once a week. It's PERSONALLY my biggest regret. A long time ago, I lost the ability to feel any euphoria from the bupe. I actually can't even get a "normal" feeling day with it. I just feel like I'm in slight W/D's all the time. No amount fixes it. 21 days without, two times, and still felt sick. Weening is a major factor in quitting it, though. Not that I fully can verify that, it's just what made it easiest for me... although I still failed in the end.

The doctors will tell you that you can ween off bupe with ZERO side effects/withdrawal. But they are playing word games, because they call it physical withdrawal, and they assure you that you are experiencing MENTAL withdrawal. But, diarrhea and almost zero energy isn't all in my head. They say you can come off from 2mg a day with no W/D. Again, 2mg a day is actually a substantial dose. It's just that when you are fresh to it, 2mg can make you throw up, but after a couple of months, 24mg in a day won't do anything different than 8mg in a day.

But, to anyone looking on help about quitting... you MUST ween down. I'm talking to where you can get by for a few days with 1/16th of an 8mg strip per day, or less would be ideal. The medicine is not evenly distributed through the strips or pills, so remember this. Weed is amazing for something to use to help soothe the symptoms and not add another addiction. Secondly, protein shakes (or other forms of protein and amino acids). Because, you need amino acids to give you the precursors to all your feel-good chemicals in your brain (dopamine, serotonin, etc.) Most importantly, it will help the most to be around people who DO know what you are going through, who you are comfortable with telling what they do that is and isn't good for you, etc. Otherwise, trying to hide what you are going through when family and friends come around feeling A-Ok... it just makes it rough being around someone with too much positive energy while you are feeling dead.

 

[Crankinit]

Once I tapered down to 16mg and found that 1mg at a time was too much to drop, I started dissolving my daily dose in water - I've found it much easier to lower the dose by smaller percentages this way. I put the 16mg in 4ml and then drip out 2 drops, increasing by an additional 2 drops every week, and so far have felt minimal symptoms. It's not fast compared to cutting up the strips, but after 4 years I can afford to go slow and steady, and I'd rather minimize the PAWS at the end as much as possible.

 

[brighton]

^ Hows your taper going?
Ive been thinking about reducing my dose from 8mg to 4mg or 2mg

I wish that replacement therapy programs just gave you an extra dose once a fortnight for a buzz. To me this makes sense - everyone I know just uses benzos on top or double doses and/or injects their takeaways.

 

[Fingers_crossed]

Precipitated withdrawal from subutex

I need help bad!! I was on about 500mg of blues (oxi) and took 60mg yesterday morning at 8am and took 8mg of Subutex at 11am and then 4mg at 1:30pm and through myself into precipitated withdrawal. What hell!!!!! Its the next day and my last Sub dosage was 2mg at 11am. I still feel really bad. My real question is do I have to wait a certain amount of time to take opiates after subs? Will it help with the withdrawal? I know I won't feel the opiates till days later... that's not my concern... I just want to get out of w/d's

 

[brighton]

^ Have a look at http://www.bluelight.org/vb/archive/index.php/t-425597.html
Theres also this new website called google.com, I find it really useful
Hope you feel better soon champ!

 

[Christ!]

But, to anyone looking on help about quitting... you MUST ween down. I'm talking to where you can get by for a few days with 1/16th of an 8mg strip per day, or less would be ideal. The medicine is not evenly distributed through the strips or pills, so remember this.

Great post. I agree with you mostly.

I think the medicine is actually evenly distributed throughout the strip (more or less). I'll try and find the PDF's I found ages ago...basically regulations for drug manufacturing sublingual strips/tablets - has to be mixed thoroughly. It might not be down to 0.0001% perfection but from what I've read, and from what I've experienced - it is very close. They're not allowed to use that as an approved form of dosing however...because it hasn't been proven to be within those strict dosage guidelines. Probably safer to do it with 2mg strips. Making a solution in water is probably more exact, as crankinit mentioned.

 

[Crankinit]

^ Hows your taper going?
Ive been thinking about reducing my dose from 8mg to 4mg or 2mg

I wish that replacement therapy programs just gave you an extra dose once a fortnight for a buzz. To me this makes sense - everyone I know just uses benzos on top or double doses and/or injects their takeaways.

Not bad, I'm only down by 8 drops (which seems to work out to roughly 8% ), I've been slack the last few weeks because I screwed up a few times and forgot to remove the drops before dosing (if anyone tries this method, be careful to make sure you don't get distracted and just dose as soon as it dissolves out of habit), and I wanted to let it stabilize before I went down further. But before that I was stuck at 16mg with even 1mg at a time feeling rather uncomfortable (probably my own fault for taking so many breaks to get high in the first year on the program), so I can't complain. I'm making progress, even if it's slow.

 

[madmick19]

i know its late but better than never, hopefully you have gotten through this:

if you take opioids then buperenorphine: the bupe will knock the other opioid off the Mu receptor (high affinity for Mu receptor)and put you into precipitated withdrawal = not fun
if you are in full withdrawal and opioid dependent then it will sit on the receptor and hold your withdrawals to the point of where your dose is rather than your tolerance is- key point (dose too low/tolerance too high)
if you have taken buperenorphine and then take opioids in the most part they will be blocked by the partial agonist affects of bupe, in medical settings some doctors (particularly anesthetists, addiction specialists) do treat possible to get over the effects of bupe with extra opioids but this is generally done on a ward where we have medical access to resus stuff as risk of respiratory depression is high du to the amount of opioids being used- IE try not to do this at home, or at least have someone by in-case you drop because that is very likely.

best thing to do at this time is take no more opioids other than bupe. more than likely your witdrawals will abate within the next 12 hours

 

[chugs]

While I don't disagree that there's a serious issue with the medical system, it's interaction with drug addicts and opioid prescription/maintenance, I think to predict that any single drug or treatment will offer a treatment for all forms of addiction, everywhere, let alone do so universally within the next 5 years, is... incredibly optimistic, at very best.

Even if this Ibudilast you're taking about really is the addiction panacea you claim (which I highly doubt), the process of getting it trialed, authorized, produced and distributed would alone take a decade or more and cost millions of dollars.

I utterly agree. The point of my post was really to articulate the mechanism of drug addiction/withdrawals which are the critical reason for chronic drug use in the face of terrible consequences for the individual.

I must admit that my previous explanations are terrible and actually wrong. I have spent the last many many weeks buried up to my eye balls in neuropsycholgy papers trying to learn how the brain works. This is probably the 9th draft/reply to this thread i've created. Anyway see below for my current explanation.

Oh My God!!!! I have been trying to find a different post that mentioned this stuff for so long! Im on methadone and have a bad(and getting worse) meth habit, plus all the clonazepam to control the side-effects of methamphetamine. This stuff sounds like a miracle drug! I don't quite understand how it works but whatever drugs I have access too(except alcohol, deleriants & psychedelics which I use properly) I will abuse the heck out of.

So here is what is happening:

There is a receptor (TL4) in your brain. When it turns on it floods your body with pro-inflammatory cytokines. These pro-inflammatory cytokines create inflammation, fevers, pain, discomfort and other stuff. Pretty much its why you feel sick when you have a virus. Traditionally it gets activated when you've suffered some sort of damage/attack. Proteins from the attack bind to TL4. I don't know what the purpose of the inflammation products are but this is the reason why we take paracetamol or ibuprofen when we're sick, to combat these pro-inflammatory cytokines. There is also a body of work that suggest that pro-inflammatory cytokines are involved in depression and other psychological disorders.

Now what appears to happen in a addict is when you were baby, stress hormones your mother made, specially cortisone, caused your brain to develop differently. There is lots of research to suggest this causes fucks up in the production of dopamine(hence kids with ADDD) but it also for some reasons unknown causes a constantly, low level activation of TL4, resulting in the production of pro-inflammatory molecules.

If you've always lived feeling sick you'll never really know any other feeling or life. This is why for those of us with this problem that first time you took drug X you felt fucking great. It was like as if a massive weight was taking off your shoulders.

As a small child committing bad behaviours, over-eating, adrenaline, anything that distracts the body from the discomfort of these inflammation products created conditioning in the individual. Do a naughty thing, get lots of dopamine/Adrenalin to rush your body, you feel good for a little while hence the incentive to keep doing the naughty stuff. Add to this the irregular supply of dopamine and you have the class early life of addict. Poor learning outcomes, hanging out with the bad kids, a history of early childhood abuse and so on.

As you get older and are exposed to opiates and for that matter most narcotics, this is where the big problem happens. When opiates go into your brain they bind to all sorts of stuff making you feel good and taking away pain. When they breakdown however a key metabolite, M3G activates TL4 causing it to create pro-inflammatory cytokines. You feel yucky and sick as a result. More opiates, more M3G and the sickness gets worse and worse.

This is the heart of what we call addiction. Its a positive feedback loop. You take opiates for pain and discomfort but they create as they are metabolised more pain and discomfort causing you to take more opiates.

It would appear that Benzodiazepines, cocaine, and methamphetamine all to vary levels in and different ways all activate TL4 in some way or another hence the fact that these hard-drugs are the ones that cause withdrawal affects and hence encourage more usage. Opiates definitely have the most direct, most powerful effect though.

So what is the cure. Well suppressing TL4. he researchers who discovered all of this have basically reduced withdrawals and tolerance so much so that in the trials and research I've seen they've basically cured opiate withdrawals. Now of course people want to get high. This isn't about stopping people from getting high. This is about stopping the physiological and psychological affects of drug withdrawals which are the number one reason for relapse.

Now you will say but chugs your sooooo wrong. What about mu-receptors, what about NA and god and faith. And what about my deadbeat uncle who got so many chances and took drugs.

Look all i know is that researchers have cured drug addiction. So much so that you can get TL4 binding drugs in high end clinics in the US - namely Ibubilast as it is already in use in various countries for several different conditions (so its already passed LD50 tests and such). The fact that clinics are all ready doing this says volumes about what I've written.

Yet there is a massive massive gravy train in addiction treatment. It will take years before this drug filters down. Drugs law enforcement, legal and correctional costs, combined with the health, productivity, overdose/deaths, and treatment, health and education costs of drugs is massive - we are talking about a global cost to the planet of something exceeding at least $2-3 trillion a year. In Australia I've estimated at least $25-30b a year.

Don't expect such a massive cog in the global economy to be fixed immediately when so many people are dependent on the money.

Also suppressing TL4 doesn't fix real root cause i.e. the broken bit in our brains that is activating TL4 thus making us feel sick.

On a personal note long before I used drugs I was constantly getting sick. I would have sniffles and aches and pains, almost all the time. I went to dozens of doctors and nothing was ever discovered or worked. Yet when i went onto suboxone I have had the longest period of good health ever. My family is very surprised. An aunt last Easter said that this was first time she had seen me not sick.

TL4 activation is the cause of drug addiction. It shows that drug addiction is not a choice. Seriously who wants to be sick all the time like this? I like taking drugs but i have found that if i am not feeling sick or awful that i tend to use my drugs in moderation. When your feeling awful all the time of course that goes out the door.

In fact its very hard to say no to drugs when you feel sick and you have the means to feel better.

-----

References. I will fill in the dozen or so papers that basically back up all that i've written. I do however need to get back to work. Reports won't write themselves.

 

[forgotten_username]

Maintaining

^ Mate you need to seek some help, bluelight isn't here to help you kill yourself. Take yourself down to the nearest hospital and tell them you're feeling this way, they'll take care of you for the immediate time being.

Mods - any way to get some help sent his way?

Cheers for the concern, man I was in a fucked up place then. Luckily I passed out from Alcohol and other shit before I could act.
But I was serious at the time. I took a massive jump in my sub dose downwards because I was worried about some legal shit, and it wasn't pretty. I was on 32mg/daily at my highest point, now on 10mg/daily 5 TA's 2 at the pharmacy.
Don't take 8-10mg jumps downwards EVER! My DR was against it completely but I said it's my program and was insistent 'cus I was trying to get off quickly for no real reason ITE other than my paranoia because I didn't want to go CT from 24mg in a cell so I was trying to jump down quick just in case some legal shit caught up with me.
If anything happens I know what an 8-10mg CT will feel like.

forgotten_username, I sincerely hope you have not followed through with what you were talking about in this thread. If you read this, please post and let us know that you are alright.

Still alive. YAY I know now what I was talking about could of been an ugly or peaceful death depending

 

[Crankinit]

Glad to hear you're alright man, hope things are going better for you and the legal stuff works out.

 

[chugs]

because I didn't want to go CT from 24mg in a cell

Unless your getting done for trafficking suboxone/subutex in a correctional facility I cannot see why they wouldn't continue your program if you received a custodial sentence.

but just to assure you correctional and law enforcement agencies will continue to dose you.

From the Opioid Treatment Program: Clinical Guidelines for methadone and
buprenorphine treatment

1.11.6

Prisons and juvenile detention centres Methadone and buprenorphine treatment is provided in prisons and juvenile detention centres under the management of
Justice Health. Patients who are taking methadone or buprenorphine when entering prison or detention will have this continued, subject to clinical review. Some individuals may commence treatment in prison. Patients who are taking methadone
or buprenorphine when released are referred to community-based service providers to maintain continuity of care.

and

Justice Health settings
■ Patients who are in an opioid treatment program when they enter prison or a juvenile detention centre
should have their treatment continued until reviewed by the Justice Health Service.
■ Other inmates may begin methadone or buprenorphine treatment while in prison or a juvenile detention
centre. The indications for treatment are the same for inmates as for the general population.
■ The transition from detention to the community involves a risk that the released inmate will return to
illicit opioid use. Released inmates should have access to public dosing and case management in their
local Area Health Service.

7.24 Patients under legal supervision
■ Public and private opioid treatment services are responsible for dosing any of their patients who are
being held in police custody, except for patients held in cells where Corrections Health nurses are
available to do the dosing. The police should inform the relevant service provider as early in the day as
possible that a patient will require a dose of methadone.
■ For dosing in cells, the patient’s regular methadone/buprenorphine provider should provide
documentation of:
◆ patient identification, including photograph and/or physical description
◆ a copy of the prescription/treatment chart for the patient
◆ verification of the time and date of the administration of the patient’s last dose
◆ verification of the number of takeaway doses (if any) provided when the patient was last seen for
dosing

 

[hazelgreen]

Hey everyone. I'm brand new to suboxone and this site. My sub doc prescribed me an antibiotic for a UTI and I've also been taking Azo..for those of you who don't know, it rids you urinary tract of the sickness and helps with the pain of going. ANYWAY, I'm going for my forth visit at 1030 this morning, and was wondering if that medicine will dilute my urine and/or make you test positive for other things. On another note almost all of the meds my doctor prescribe could make me test positive for something I wasn't taking. I always keep my meds on me and have a print out of the meds that can cause a false positive and for what. I'm worried about getting kicked out of the program because I feel like a new person when I take it....well if anyone has answers to my concerns I'd appreciate it. Thanks

 

[the_ketaman]

Im sure its already been mentioned but who else has noticed meth addicts being put on methadone?

I know quite a few and I think its absolutely wrong for them to put someone one a drug that 1. isn't going to stop them from using ice, 2. Will become another stressful addiction than im sure the person doesn't need, adding physical WD's to an already rattled person could end bandly. and 3. Theyre not even related substances, ones a stimulant, the other a opiate analgesic and I cant see any reason why methadone would help an ice addict?!?

It just doesn't make sense and it looks to me like the doctors are setting these people up for their own benefit

 

[Crankinit]

I'd imagine it has less to do with their own benefit and more to do with a sense of frustration. Doctors get very put off when they're faced with a problem they can't solve by throwing a medication at it, so I guess some of the less educated ones are just thinking "well, it works for heroin addicts and it might make them feel better" and not looking into the deeper issues beyond that.

 

[CfZrx]

ANybody love Bupe for pain?

 

[chugs]

Hey everyone.

Hello

was wondering if that medicine will dilute my urine and/or make you test positive for other things

.

Yes there are many medications that can cause a false positive. Your doctor needs to list these medications in your pathology order so they can be anticipated.

Now urine can only be diluted literally by large volumes of water. This is the worst way to defeat a urine test because they can test for extremely diluted urine and it in itself is a sign that your trying to cheat. Though if you have a medical certificate and your doctor can verify it with your prescriber I guess if you were drinking large volumes of water for your UTI that you might get away with it for the duration of your illness.

The best way to defeat a urine test, as a FYI, is to eat. Eat a lot and frequently. That and do exercise. What your trying to do is get your metabolism rev'd up so you cycle as much as you can through the kidneys and liver. Drinking large volumes of water actually slows your metabolism down. Furthermore because you're full from the water you tend to slow your eating which means less energy which in turn causes your body to slow down. And then to pile ontop of all of that is the heroin use which really slows your metabolism.

Also if your taking fuck loads, like a gram a day, it'll take longer to cycle through.

Eat, exercise, fuck and eat b-group vitamins (berocca etc). Not because the Berocca defeats the test but because it also ups your metabolism. green apples are also really good.

I'm worried about getting kicked out of the program because I feel like a new person when I take it....well if anyone has answers to my concerns I'd appreciate it. Thanks

There are only a few ways to get kicked out

1. be violent (and even then i suspect you'll be allowed back in after a time/contrition/strict conditions).
2. drug dealing etc.

I know people who have been on the program for 15 years, giving dirty urines for at least 10 of those years. Shit they don't even turn up half the time for their dosing. Anyway at the end of the day urine testing is not meant to be used to punish you i.e. suspend you from the program. Per the below

In Opioid Treatment Program: Clinical Guidelines for methadone and
buprenorphine treatment

4.6.2 Urine drug testing
Urine drug testing is a difficult area over which patients, prescribers
and managers disagree. Ideally, it is one method of
monitoring the progress of patients during treatment, including
detecting extraneous drug use or occasionally detecting
methadone or buprenorphine diversion. It should never be
used in a punitive way, and overall health and social functioning
should not be overlooked as indicators of progress or
change.

 

[chugs]

I'd imagine it has less to do with their own benefit and more to do with a sense of frustration. Doctors get very put off when they're faced with a problem they can't solve by throwing a medication at it, so I guess some of the less educated ones are just thinking "well, it works for heroin addicts and it might make them feel better" and not looking into the deeper issues beyond that.

Actually there is research that suggests that opiates, meth and coke activate the TL4 receptor which in turn creates the feeling of withdrawals. TL4 when activated creates proinflammatory cytokines. THese little fuckers are what make people feel sick. They give you fevers, inflammation, nausea and have been implicated in psychological illnesses i.e. depression.

The theory goes that in addicts something is causing TL4 to make these proinflammatory cytokines albeit at low levels, from childbirth. Exposure to cortisone is the leading contender. Because you've always felt sick you cannot know what it feels not to be sick.

In the case of opiates its a really interesting mechanism. The metabolites of heroin, M3G and M6G do two things. M6G is the shit that makes you high. Whilst in the past everyone thought that M3G did fuck all. A researcher discovered that M3G was binding to TL4 causing to make all those nasty withdrawal feelins/sickness.

Giving them methadone is a way of sating TL4 - stopping you from feeling sick in principal. This would in turn reduce your need for any drug (in principal).

Though sadly i doubt this is why the doctors are giving people methadone when they're not even opiate addicts.