methadone, buprenorphine and other opioid pharmacotherapies

[tentram]

Doesnt sound like your PHARMACIST has a full grasp of pain mgt goony. Or hes just suggested it because of the arrangement you have picking up your fent - id be inclined to think a client may be abusing from that not that hes treating you sny different nor should for the obvious reasons. So he might just think youre on opioids long term, why not suggest a maintenance program.

Most doctors simply start titrating you down on the current opioids youre using, possibly dropping to a weaker one if you can handle it.

If you get unhappy with their demeanour toward you find a different chemist.

 

[Nozphexezora]

I have an appointment with ATODS at 10am tomorrow for my suboxone treatment. The problem is, I dosed at 3pm yesterday and, in desperation, did a 3rd rewash at midnight which did nothing. I'm just wondering if that's enough time (~34 - 43 hours) for me to not enter precipitated withdrawal from the suboxone. I'm probably just being paranoid, as usual, but I just thought I'd get some validation.

 

[footscrazy]

^ I would say you're definitely fine. I think 24 hours is playing it safe, and that's with long lasting opiods such as those in pst (or maybe that's what you were talking about? I assumed wash meant codeine, but it could mean pst...). I don't think I've ever waited longer than 24 hours to dose sub after pst. I couldn't wait 34 hours, I'd be sick and whinging my arse off by then.

 

[Nozphexezora]

^ I would say you're definitely fine. I think 24 hours is playing it safe, and that's with long lasting opiods such as those in pst (or maybe that's what you were talking about? I assumed wash meant codeine, but it could mean pst...). I don't think I've ever waited longer than 24 hours to dose sub after pst. I couldn't wait 34 hours, I'd be sick and whinging my arse off by then.

Keep in mind I don't have any subs in my system. I'm sure I'll be fine, as I'm getting some withdrawals now.

 

[footscrazy]

^ What? Maybe I'm misinterpreting your post, but of course I wouldn't assume you had subs in your system, or why would you be worried about precipitated withdrawals? What did you think I was talking about?

 

[Nozphexezora]

^ What? Maybe I'm misinterpreting your post, but of course I wouldn't assume you had subs in your system, or why would you be worried about precipitated withdrawals? What did you think I was talking about?

I've been getting my sources from shitty "medical" sites and they threw around a bunch of misinformation until I looked at it further. To be honest they didn't help at all. People were claiming that I would have to wait 48 hours before taking subs after a regular opiate dose regardless of whether or not I had subs in my system before; which is why I asked the question in the first place.

EDIT: Also, the first day went sort-of okay. They gave me 4mg and I still felt relatively sick the entire day. I was going to return, like I could, but I didn't want to waste their time so I just sucked it up and waited until today.

 

[footscrazy]

Ok, after giving it some thought I think I get what they mean. I have always gone by the rule that as soon as I take a full agonist opioid, the waiting period applies, regardless of the last time I took bupe. So if I've taken sub in the morning but decide to do a pst in the evening, I'll be waiting 24 hours after the pst before I feel it's safe to take sub again. Same if I did a pst straight after taking bupe, it's another 24 hours before I'll take anymore bupe.

But, just thinking aloud, bupe causes precipitated withdrawals because it has a higher affinity than other opioids, so it immediately pushes any full agonists out of their receptors and then only partially replaces the agonist effect. Considering this, if you were to take heroin straight after bupe, it would have little or no effect, as we're all familiar with, as the receptors are already full with bupe, and the heroin can't get in. So it makes sense that if you were to take bupe again straight after that, the risk of precipitated withdrawals would be much lower - the bupe won't be removing any heroin and causing precipitated withdrawals, because the heroin never got in in the first place.

I suppose it does follow that for as long as any sub is in your system and is binding to some receptors, the degree of precipitated withdrawals would be reduced. Personally, I still wouldn't risk it though. Not to mention, I never switch back to a full agonist from bupe for less than 3 days anyway - there's no point, as it takes around this long for the bupe to clear and for them to work at full effectiveness again.

EDIT: Also, the first day went sort-of okay. They gave me 4mg and I still felt relatively sick the entire day. I was going to return, like I could, but I didn't want to waste their time so I just sucked it up and waited until today.

I usually get by fine on around 2-3mg a day, but I've always noticed on the first day or two being on bupe I need around 6-8mg to feel comfortable. After that first day or maybe two, though, I'm fine to settle down to 2-3mg. I think you might find that you do feel a lot more comfortable on 4mg or even less in a few days.

 

[Ashley]

But, just thinking aloud, bupe causes precipitated withdrawals because it has a higher affinity than other opioids, so it immediately pushes any full agonists out of their receptors and then only partially replaces the agonist effect. Considering this, if you were to take heroin straight after bupe, it would have little or no effect, as we're all familiar with, as the receptors are already full with bupe, and the heroin can't get in. So it makes sense that if you were to take bupe again straight after that, the risk of precipitated withdrawals would be much lower - the bupe won't be removing any heroin and causing precipitated withdrawals, because the heroin never got in in the first place.

Regarding this, while the way you explain buprenorphine to work by means of pushing any agonists from the receptors is correct, the process is by no means 100% effective. For instance, to demonstrate, if I was to take 2mg buprenorphine IV, and then inject 100mg of diacetylmorphine immediately or soon after, I would certainly feel the heroin, albeit it would be dulled somewhat, but not to a massive degree (at least not in my experience). If I was then to follow the shot of heroin with a 2mg taste of buprenorphine immediately or soon after, then I wonder what would happen? Instinct and a vague memory of past experience doing something along those lines tells me that I would not go into full on precipitated withdrawal, as despite having ingested 4mg of buprenorphine in total, the heroin acting as a full agonist would certainly still remain to a degree dominant. If that made any sense at all, theoretically a certain dosage of buprenorphine would eventually induce precipitated withdrawal, if you increased it exponentially.

At some point in my adventures, I have injected >2mg buprenorphine following a dose of heroin as little as 4 hours after with no ill effect. I have a pretty fine internal radar when it comes to knowing if it will make me sick or not. In 7 years of using I have never given myself precipitated withdrawals.

A.

 

[Nozphexezora]

Ok, after giving it some thought I think I get what they mean. I have always gone by the rule that as soon as I take a full agonist opioid, the waiting period applies, regardless of the last time I took bupe. So if I've taken sub in the morning but decide to do a pst in the evening, I'll be waiting 24 hours after the pst before I feel it's safe to take sub again. Same if I did a pst straight after taking bupe, it's another 24 hours before I'll take anymore bupe.

But, just thinking aloud, bupe causes precipitated withdrawals because it has a higher affinity than other opioids, so it immediately pushes any full agonists out of their receptors and then only partially replaces the agonist effect. Considering this, if you were to take heroin straight after bupe, it would have little or no effect, as we're all familiar with, as the receptors are already full with bupe, and the heroin can't get in. So it makes sense that if you were to take bupe again straight after that, the risk of precipitated withdrawals would be much lower - the bupe won't be removing any heroin and causing precipitated withdrawals, because the heroin never got in in the first place.

I suppose it does follow that for as long as any sub is in your system and is binding to some receptors, the degree of precipitated withdrawals would be reduced. Personally, I still wouldn't risk it though. Not to mention, I never switch back to a full agonist from bupe for less than 3 days anyway - there's no point, as it takes around this long for the bupe to clear and for them to work at full effectiveness again.



I usually get by fine on around 2-3mg a day, but I've always noticed on the first day or two being on bupe I need around 6-8mg to feel comfortable. After that first day or maybe two, though, I'm fine to settle down to 2-3mg. I think you might find that you do feel a lot more comfortable on 4mg or even less in a few days.

I hope that's the case. Now I'm on 12mg because I still go into withdrawal from the 8mg yesterday. Maybe I don't work that well with bupe. I know it's a strange drug so it wouldn't surprise me.


Thanks for the comment, Ashley.

 

[opi8]

^ Not really funny in my personal opinion. Inevitable may be it.

ok.. and IF I'm right, which personally I think I am... look at my avatar and think... WHY SO ILLE-GAL ?

 

[Nozphexezora]

^ Not really funny in my personal opinion. Inevitable may be it.

ok.. and IF I'm right, which personally I think I am... look at my avatar and think... WHY SO ILLE-GAL ?

I don't mean to impose on your beliefs, but do you really think that the populace will be able to manage a non-criminal, harmless addiction any more than opiates being illegal?

Also, goonbag, I think he just meant that the irony behind your comment is surprisingly common. I wouldn't know, but I could imagine people get addicted to these kind of drugs after getting in a car accident or getting a tooth pulled out etc.

 

[opi8]

I don't mean to impose on your beliefs, but do you really think that the populace will be able to manage a non-criminal, harmless addiction any more than opiates being illegal?

Yes.

Also, goonbag, I think he just meant that the irony behind your comment is surprisingly common. I wouldn't know, but I could imagine people get addicted to these kind of drugs after getting in a car accident or getting a tooth pulled out etc.

Correct.

What do you mean, was that a go at me?

Not having a go at you, just stating my opinion on addiction to opiates after an injury is common.

 

[footscrazy]

When I first take sub again after using other opies for awhile it seems to make my cravings worse. I was completely cool about taking sub this morning and deciding against getting smack tonight, until I took it. Then straight away I think fuckkkkkkkkkkk why did I do that!? All I can think about is all the dashed opportunities to take heroin or other opies and how I have to wait ages until they'd work properly again. Fucking shit, this has happened before

 

[Nozphexezora]

When I first take sub again after using other opies for awhile it seems to make my cravings worse. I was completely cool about taking sub this morning and deciding against getting smack tonight, until I took it. Then straight away I think fuckkkkkkkkkkk why did I do that!? All I can think about is all the dashed opportunities to take heroin or other opies and how I have to wait ages until they'd work properly again. Fucking shit, this has happened before

I've found the suboxone to work pretty fucking well so far. No high, more energy and a clearer head. I have a few cravings but nothing I can't handle. The only problem is that I have trouble getting to sleep since I'm so used to using in the afternoon/night, and its half-life seems a little short but with the dose I'm on now I should be right.

 

[the_ketaman]

It seems I cant win! I got off the suboxone a few weeks ago, had been on it for years then methadone before that then oxy before that, and now that im off it I dont crave constantly but when I do, I find it so hard to not use. Methadone was great for me, I think I only used opiates 2-3 times the whole 2-3 years I was on it but as soon as I switched to bupe I used a lot more and I never really had to worry about withdrawing, so it got a little out of hand after than. By the end though, it was taking up so much of my life(I had troubles giving urine's in front of people so I couldnt get take-aways) and I decided I wanted off the shit. But now im back using again, its just a continuous circle. I knew it was hard but until your going through it you dont realise how hard it really is to rid yourself of opiates/heroin. I enjoy other drugs but theres nothing I love like I love heroin.

So to all doing well on the program I applaud you and even though it may seem like it totally sucks, even most of the time it is really doing its job. And I hope you guys are getting what you want out of it, and if you use a little on top then that can just be life. Just dont be like me and use pretty much every day because it defeats the point of being on maintenance. If only you could get 7 takehomes a week, id still be on the stuff but how do they expect people to hold jobs getting 4 a week. I think they even cut it down to 2 a week at my local clinic! I suppose its kind of understandable as nearly everybody shoots their methadone and the rest probably gets sold, but there are other options I think.

 

[JeanJM]

Some may hate me for this but I think addicts should be given the purest form of their opiate at a controlled comfortable level instead of being put on Methadone/suboxone. Why force an addict to come off something they don't want to and isn't interfering with their lives as long as the drug is available? I just think Methadone/Suboxone is worse for the body/mind especially in the long term.

 

[Nozphexezora]

Some may hate me for this but I think addicts should be given the purest form of their opiate at a controlled comfortable level instead of being put on Methadone/suboxone. Why force an addict to come off something they don't want to and isn't interfering with their lives as long as the drug is available? I just think Methadone/Suboxone is worse for the body/mind especially in the long term.

Professional pharmacologists, physicians, nurses and doctors alike all agree that buprenorphine is especially helpful for drugmaintenance for many reasons. Not only is it financially affordable, but it's sched. 8, has a very long half-life and is sublingual - making it an appropriate constituent with naltrexone. There are other reasons, such as its antagonist properties and partial agonist properties (only the norbuprenorphine is apparently fully agonistic). Methadone has similar qualities, although I agree that methadone isn't much better than most other opiates - especially for replacement. Just remember that professionals have decided that this drug in particular works remarkably better than other agonist opiates like morphine or heroin. call me naive or conformist etc., but the people who reach this conclusion have gone through a lot of training to come to a conclusion through academic studies and scientific observations. And it's not just national; it's international.
Personally, I would rather have suboxone than any other opiates for the reasons I gave above. If they have the option of supplying any opiate then they might as well legalise the class of drugs and just put an age restriction on it.


How's your use going anyway, Jean? Still cutting back?

 

[tentram]

^yeah but these guys making those decisiond have likely never been addicted to opioids of any sort therefore all their propositions run on pure theoritical conclusions. anecdotes should weigh in heavy when coming to such conclusions.

for eg the swiss and UK heroin replacement orograms are highly successful.

im nor saying methadone and bupe are useless for ORT as they change many peoples lices whereas others have no such luck. like in switzerland and the UK, those who continually fail at recovery attemots on either bupe or done, time after time, should have the allowance if trialling their opioid of choice for the program.

from statistics and personal experience using oxy and morphine for my maimtenance/pain meds instead of bupe or meth im a lotmore functional.

 

[the_ketaman]

I found methadone to be very helpful with the pyshological cravings, I used a handful of times when I was on the program as I simply lost interest, I think the fact that its a full-agonist makes a huge difference because while bupe was undeniably helpful, I ended up getting back into using while I was on it and the cravings were mostly still there. The reason I cant see myself getting back on methadone is that 4 takehomes a week is nowhere near enough for someone who has aspirations in life(the desire to study or even just having a job) and wants to go somewhere in life, especially if your living where I am but you need to study in Sydney. My cllinic has even changed the rules to 2 TA's a week unless your on pharmacy then you can get 4. I had no life when I was on the program and is one of the biggest reaons I decided to get off it, but I also realise it saves peoples lives and its a miracle for some people, I just wish it were the same for me :/

Its also a massive shame the amount the stuff gets abused, many people I know sell their bottles of 'Done and just as many if not more inject the stuff(I cant be a hypocrit I never sold it but I injected it a lot) So I can see why the powers that be dont want to increase the TA's and fix other problems because many people are just fucking it up for themselves and others and just dont care, its a massive shame. Bupe doesnt seem to be getting abused that much anymore since they changed the suboxone formula to strips. Almost everyone I know who's been to jail tried smoking bupe in there but now that its a film you dont see too many people abusing it which is great.

Good luck to the people on the program who are trying to do well, its one of the best ways to do it.

 

[JeanJM]

What I mean is why can we not be given our DOC in a steady controlled amount until the person decides (some can use forever) to come off ourselves?(yes we will pay for it ourselves also) So many people just go about their daily lives dependent on a substance like it doesn't exist yet it becomes a major problem when one is forced to stop what they are dependent on because some d!ck who's never taken drugs in the first place says so? You can tell I'm angry because I fall into this category. I want to live my life how I see fit, I'm happy to be dependent on a substance and go about my business. I don't drive or work in a safety conscience area, my family supports me no matter what, no one has ever been hurt by my use and never will be except maybe my own mental welfare because I don't view it as fair and it really upsets me and makes me wonder what the hell is the point if some random can decide what I do with my body/mind?

The drug laws are BS! The way media portrays drugs and drug users is BS!