Bupe Need an answer fast

[Jacksterini]

My boyfriend has no opiate tolerence and took 2 mg suboxone under his tongue he is out of it he can barely walk now hes sleeping. How long will this last? Is he ok ? Is there anything i can do to make it stop. Please hes in no position to miss work

 

[TheOneWhoSees]

Miss work?! He could die of respiratory depression and may need Narcan. You're very unlikely to die from a 2mg suboxone but I wouldn't say it's immpossible.

 

[Tommyboy]

^ They need very high doses of narcan to reverse suboxone withdrawal since the suboxone has a higher affinity to the receptors, which is why I said they would have to tell the emergency services that's what he took. However, suboxone overdose is not likely when suboxone is the only drug taken, especially at a low dose of 2mg.

Looks like he is going to miss work. The half-life of suboxone is very long, so if he is that messed up right now, he won't be much better until probably close to 24 hours after he took it. The first time I took suboxone I couldn't even drive the next morning, so he should be prepared to call in sick.

Is he ok? Well, did he take any drugs other than suboxone? Suboxone itself isn't as bad as other opiates in terms of the amount of respiratory depression, but if he mixed it with other CNS depressants (alcohol, benzos, etc) then it is a lot more dangerous. Monitor his breathing while he's sleeping, and if it gets too shallow and/or his color gets bad then call an ambulance and tell them exactly what he took.

Is there anything you can do to make it stop? No. Like I said, it has a very long half-life (37 hours on avg) so time will be the only thing that will help.

 

[TheOneWhoSees]

Is there anything you can do to make it stop? No. Like I said, it has a very long half-life (37 hours on avg) so time will be the only thing that will help.

Well if they have access to Narcan they can make it stop but the binding affinity of suboxone is very high so Narcan will only have limited effectivity.

 

[BiggDirty01]

As everyone else said, he needs immediate narcan treatment. I don't understand noobs who just say "oh I got this pill so I'll take it". BL exists for this very reason, to reduce harm BEFORE hand and not after the damage is done.

 

[Cane2theLeft]

Ive never heard of narcan being necessary from bupe alone. There is a ceiling on the agonist effects below what it would take for the majority to OD, even the opioid-naive (unless someone is particularly sensitive, tiny, has impaired health, elderly, etc.)

The only times I have heard of naloxone being used were when, as Tommy mentioned, other CNS depressants were involved and respiratory depression reached dangerous levels. They would have to use massive doses typically repeatedly given the binding strenght of buprenorphine and half-life of it compared to the meager half-life of naloxone.

I'm not saying that everyone should go out and give buprenorphine to opioid-naive individuals but relatively speaking, bupe alone is far more benign than most recreational (full-agonist) opioids.

Tommy gave great advice, please use it and for god sakes, whoever decided it was a good idea for him to take 2mg bupe without a tolerance, do some fucking research FIRST.

 

[Tommyboy]

Well if they have access to Narcan they can make it stop but the binding affinity of suboxone is very high so Narcan will only have limited effectivity.

They have access to narcan, but it's in the suboxone. In hospitals they give something like 10X the normal dose of narcan to people suffering from suboxone overdose, and even then it's not very effective they rarely use it, so I doubt the OP would be able to help. Suboxone doesn't cause that bad of CNS depression though, so it doesn't result in overdose on its own much.

Even in cases when kids got their hands on an 8mg tab they were usually just monitored at the hospital and narcan was rarely administered. Most suboxone overdoses are from a combo of suboxone and a benzo, and they actually treat the benzo overdose using flumazenil instead of treating the suboxone OD with narcan since the narcan doesn't work that well in treating suboxone OD.

 

[ErgicMergic]

I'm guessing he took the most dangerous dosage of Suboxone. If he had taken any more than 2mg, the bupe would antagonize the norbupe, but now it's pretty much acting is a powerful full agonist, equivalent to 80mg oral oxycodone IIRC

Tommyboy, wouldn't 8mg cause less respiratory depression than 2mg, as the bupe antagonizing the norbupe (full agonist) at the 8mg dosage is only a partial agonist?

Keep an eye on him, OP, he's going to be sick for a while

 

[Tommyboy]

^ My understanding is that the respiratory depression does not get any worse above a dose of around 4mg I think. I don't know the pharmacology behind it though, and don't really understand how it antagonizes itself or the norbupe.

 

[Cane2theLeft]

I've seen that mentioned several times around here but I've never really understood it either. I had a training seminar with representatives from Reckitt Benckiser on Buprenorphine for addiction counseling continuing education credits and this wasn't discussed at all. Furthermore I've seen loads of reports of people around here who were unfamiliar with pharmacology of bupe who took large amounts regularly and did not replicated this phenomenon.

From my understanding, the agonist effects level out between 2mg and 4mg depending on the individual and larger doses are only used clinicaly to keep individuals from dipping below this threshold ever to maintain steady plasma levels as well as produce a blockade effect for a greater duration. At larger doses, the blockade effect stops being elongated and nothing else happens hence the 32mg limit for prescriptions. Because it blocks the receptors after a certain level of agonism and they can only be blocked for so long, it loses any greater effect after a certain point which for most people is well below the 32mg even.

If anyone can provide backing for the 'antagonizing itself' (aka producing LESS agonism at larger doses), I'd be very interested in learning about this both out of curiosity and for future professional use.

 

[helium-4]

I'm pretty damn sure the antagonizing itself is happening at the kappa receptors, not the mu receptors. I need to refresh myself with bupes pharmacology, but I Do know the metabolite of bupe has the opposite effect at the kappa receptors than bupe itself, but it isn't that much stronger to strip all of the bupe off.

 

[Cane2theLeft]

Bupe certainly is a kappa antagonist and a mu opioid receptor agonist-antagonist (which I feel is a better description than partial agonist... it fully agonizes the mu receptors to a point then becomes an antagonist to other opioids beyond that).

 

[helium-4]

Bupe is a kappa antagonist, but I believe some/one of the metabolites is an partial agonist or agonist at the kappa receptor. I know I have a paper somewhere talking about this. I'll have to look for it tomorrow.

 

[Cane2theLeft]

whoops. I meant kappa antagonist. I mistyped.

/fixed

 

[phatass]

let him sleep it off... make sure he's lying on his side so if he were to vomit he wouldn't choke on it and die... 2mg isn't OD territory for your average person... but i have a friend who did 2mg (no tolerance) sniffed and pked for hours...

the effects will last 24 hours in theory.... keep an eye on him, but it should be fine IMO

 

[Jacksterini]

Thank you. I appreciate the educated responses. He thought he has a high tolerence to other drugs. But is drug free he took suboxone for pain. He can wake up speak his blood pressure is ok. Just tired and sick he tried to get to work but had to come back home. Im hopin this is the worst of it I wish there was something that would make it faster. Hopin in the 24 hrs hel b good. Iv been on suboxone and his friend gave it to him and he thought if i could take it he could I dunno wtf is wrong with both of them im stingy with my meds cuz i have to track them with my doc i gues others arent

 

[80mg]

Thank you. I appreciate the educated responses. He thought he has a high tolerence to other drugs. But is drug free he took suboxone for pain. He can wake up speak his blood pressure is ok. Just tired and sick he tried to get to work but had to come back home. Im hopin this is the worst of it I wish there was something that would make it faster. Hopin in the 24 hrs hel b good. Iv been on suboxone and his friend gave it to him and he thought if i could take it he could I dunno wtf is wrong with both of them im stingy with my meds cuz i have to track them with my doc i gues others arent

He sounds okay. Make him some coffee. And a kick in the ass.

-80

 

[faceplant]

Thank you. I appreciate the educated responses. He thought he has a high tolerence to other drugs. But is drug free he took suboxone for pain. He can wake up speak his blood pressure is ok. Just tired and sick he tried to get to work but had to come back home. Im hopin this is the worst of it I wish there was something that would make it faster. Hopin in the 24 hrs hel b good. Iv been on suboxone and his friend gave it to him and he thought if i could take it he could I dunno wtf is wrong with both of them im stingy with my meds cuz i have to track them with my doc i gues others arent

Glad to hear hes ok. Hopefully he wont be doing this again. For me anyway, something cold to eat is always nice the times ive felt like that, icecream is good. And then a kick in the arse, and possibly another.

 

[Tommyboy]

Suboxone/buprenorphine is some potent stuff, and a lot of people don't give it the respect it deserves. The majority of people are surprised at how potent suboxone is when they first try it, and most of those with low tolerances get sick the first time they take it. I know a lot of people that had a relatively low tolerance (able to get really high off of like 50mg of hydrocodone) so when they took 2 or 4mg of suboxone they were puking for hours and it took almost 2 days for them to get back to 100% again. He will probably feel shitty for the rest of the day, but will be back to normal tomorrow.

1mg buprenorphine (sublingual) ≃ 25mg oxycodone (oral),
so what he took was similar to 50mg of oxycodone or 80mg of morphine (oral)

 

[Znegative]

^what shocks me is how ready and willing doctors were to hand suboxone out at outpatient programs a few years back. I was put on suboxone after 6 months of light, insufflated heroin use, and bupe was the first opioid I actually became Dependant on.

I've been seeing a lot of talk about norbuprenorphine going on lately, and I want to say that there is not really any concrete evidence, (that I've read at least) that norbuprenorphine is what makes low dosages of bupe more euphoric, or effective as a painkiller. It could quite simply be that when you're at a low dosage like 2mg, each time you dose, you feel the effects way more as your receptors are not completely saturated with buprenorphine. It's kind of like how that first shot of heroin in the morning gives you the strongest rush-because it's been over 6 hours most likely since you last fixed.

I just don't want people to get the idea that 8mg is safer than 2mg. I feel quite confident that even with the less is more "principle", that this would be a mistake to tell people. Buprenorphine does continue to produce increased agonist effects up until a point, and then it plateaus. Unfortunately no one knows what the exact ceiling dose is.