Rule of thumb is to wait 24 hours after your last dose to avoid precipitated withdrawl. If your goal is to get clean then you should NOT take oxy with your bupe. The binding effect of the bupe is so strong the oxy would be pointless and if you have suboxone the naloxone will completely block the oxy. What dose of bupe are you on?
My unsolicited advice is I don't think you should use bupe at all. For the dose you're taking I think you'll end up with a stronger dependency on bupe than the oxy.
Buprenorphine withdrawal is longer and more intense than a traditional opiate. The only way to avoid this is to take it for a very short period of time (1 week max) and start lowering your dose after the third day.
There's a chance you're psyching yourself out a bit and your anxiety of withdrawal is making the symptoms seem worse.
Take kratom. That stuff was a godsend for me. And you won't end up with a worse habit like you can with buprenorphine.
More or less accurate.
In the OP's case, if she is really struggling with coming off oxycodone then buprenorphine does make sense. First she needs to decide if she wants to use it just to medicate the acute withdrawal, taking it for about 7 days tops, or if she feels like she needs the support of maintenance.
There actually isn't any issue with becoming dependent on buprenorphine if the pros outweigh the cons for the individual. If someone is really struggling to stay sober and not use other opioids, it may make sense even though maintenance will eventually mean dealing with dependency if she decides to come off down the road. That said, coming off buprenorphine is not nearly as difficult as a lot of people experience. With a proper taper, support and comfort meds it is very, very manageable. It just takes a lot of time and careful planning.
A high dose of buprenophine would totally be overkill for the OP's habit, for sure.
Thank you, but I can't do kratom.
I have decided to up my dose of oxy to where I am just comfortable, and enjoy the next few days until I can get a complete plan with the doctor to get off of it and bupe.
She started me at 8, I think. But I have read repeatedly to start low and take my time building to find the correct dose. Then keep it at the lowest dose, then taper when the OXY w/ds should be over.
I want to know if I can still take my comfort meds while waiting to start bupe? Can I take my .5 Ativan and Clonidine? They wouldn't affect the amount of oxy in my system, and that's the important thing, right?
Because I have unanswered questions, I will wait.
My w/d symptoms last night started before my regular 12hr dose.
I think this is your best plan.
Yes, if you are having problems with your taper comfort meds will definitely help. Just be careful not to over do it with them as they will potentiate your opioids (and be potentiated by the opioids themselves).
Do not mix sub and oxy, pointless. Make sure you're at at least a 16-18 on the cows sheet, with 20-26 being ideal. Start small, .5mg every hour, until your comfy. Less is best. Unless you want to do a quick taper. Then dose higher on day 1, which helps the smaller doses of day 2-3 keep you feeling ok, because of the long half life.
General speaking, yes, buprenorphine and full agonist opioids should never be taken together.
With the transition to buprenorphine, the COWS scale is okay, but I have never found it very useful. Generally speaking I damn sure as well know when I'm in full blown withdrawal. With the exception of super huge habits and long acting opioids like methadone, it seems very very rare for people to need to wait more than 24 hours.
Starting buprenorphine at a low dose doesn't help avoid precipitated withdrawal. It would be a good idea in the OP's case though, because she probably won't need too much buprenorphine to get/stay well and treat symptoms of acute withdrawal.
Maam, i can if i can give you any advice, this is it, there's many people in these forums that know 100xs more than your dr about suboxone, guaranteed. The drs take a one day class, get their license, and start raking all the way to the bank. Ive personally done hundreds of hours of research, looking at others threads, learning about the drug itself, and others in here know way more than me. Your dr did an 8hr course, and i guarantee that's as far as he's gone with his research. If he wanted to start you on 8mg, that tells ya right there, he knows nothing about it.
Absolutely. The most important thing is that the OP learn about her potential treatments, educate herself and advocate for what she feels her genuine needs are with her doctor. If the doctor takes an "I know best and if you try to suggest what is best for you I'm going to treat you like a child" approach, sadly common among medical professionals who work with substance use disorder, that is a sign you're better off finding another doctor who is willing to work WITH you to accomplish your goals. They can be difficult to find, but they're definitely out there.
In my experience suboxone is really not appropriate for your situation. 20mg of oxy per day to 8 mg of suboxone would be literally doubling your dose in not tripling it. OP before you get on suboxone please go look at an opioid equivalency chart and dose accordingly. That is if you really want to get off narcotics.
An appropriate dose per NAABT would be about 0.25-0.5 mg of buprenorphine per day. Try tapering you dose of oxy down from 20mg a day to 2.5 mg over a ten day period. Then try and stop with some basic non narcotic comfort meds.
If you did tell your doctor that you only took 20mg per day of oxy it is my opinion that she or he is incompetent and sending you down a dangerous path. Prescribing you 8mg per day is ridiculous. Unfortunately this is a common occurrence in this industry. If you do happen to get on Suboxone you will literally feel better on a dose below 4mg. Wait at least 18-24 hours before taking the sub. You should be doing the induction in your doctor's office. Hay maybe your doctor might learn something.
There is actually nothing inherently inappropriate with a doctor prescribing buprenorphine to treat acute opioid withdrawal (as well as as a maintenance treatment for substance use disorder). It all depends on whether the OP needs it, or if she could just be fine with gabapentin, clonidine, etc. Prescribing it like it is a magic bullet is inappropriate, but that goes for any med.
She might not have a huge dose, but a lowish dose of buprenorphine (IV they are equanalgesic @ 20mg oxycodone = 0.3mg buprenorphine) would be very appropriate to treat the acute withdrawal if the OP is struggling dealing with it.
If you doctor isn't going to prescribe you gabapentin and clonidine to treat acute withdrawal, regardless of the buprenorphine, that is a sign you need to find a doctor who has a clue about treating acute opioid withdrawal.
Thank you all for your concern.
I could NOT drop from 30 to 20mg without w/ds that exceeded my comfort meds. I am now comfortably back to 30mg and learning to breathe. I have suffered under this taper for a month, extending my use of Oxy past the need.
I am 8 weeks post op from hip revision surgery. I was on bed rest for six weeks and now my muscles are atrophied (I have muscular dystropy). I just started PT this week and my wound site is filled with adhesions.
I need to push past this so I can recover completely. It is a physical dependence. I have no emotional ties to Oxycontin and do not get high.
I know my doctor is new to this. That is why I decided to hold off on the bupe until next week when we will have another meeting and then confer with my pharmacist, who has been a huge help.
Many people have used subs without medical supervision, using the information they get online. I at least have two attending doctors to consult and a pharmacist.
I am reading the boards and see a seven day plan. I know I will start either at, or less than 1mg. If anyone wants to help me to put this plan together I would consider every insight.
In the end, the plan will go through these two doctors (family and pain management) before I start. I just want to come in with something of my own instead of taking their suggestions as gospel. I KNOW 8mg is too high for most people. I know to only take enough to cover the w/ds and to keep my eye on the bupe.
That's why I wanted to know about taking clonidine and valium during sub. I can take less sub if I can contain the w/ds.
My pharmacist just called me to report that he spoke with the doctor and they are working on something. So I'm not worried.
Edited to say: I LOVE that you care enough to even write anything. I truly do. This is an extraordinary community of lovers.
My favorite new song right now:
'Cause your scars shine like dark stars
Yeah, your wounds are where the light shines through
So let's go there, to that place where
We sing these broken prayers where the light shines through
Where the Light Shines Through - Switchfoot
Given how you've struggled with your taper, it leads me to believe that a buprenorphine detox would be very appropriate for you. The details of using buprenorphine in your case are pretty general though.
(1) Take as much buprenorphine as you need for the symptoms of acute withdrawal about in increments of 2mg sublingual every two to four hours.
(2) Once you find a dose that helps alleviate your symptoms (which will probably be between 2-6mg), stick with that dose.
(3) If you find you need to dose twice a day (rare but it happens), do not dose more than twice a day.
(4) If you're only using buprenorphine for treating acute withdrawal, you don't need to use it for more than a week.
(5) You won't
need to taper off the buprenorphine, as you won't be on it long enough to become dependent. HOWEVER it may help to taper off it over another week, as you'll probably have some linger symptoms for your oxycodone detox. If you just want to stop it after a week, you should be able to treat any linger symptoms with the meds you already have though.
Good, i really think his way is ideal. The first days big dose, helps the next 3 days smaller doses because of the long half life. He documented how much sub was actually left in his body a couple times, so you know he did extensive research on this. The only thing i couldn't find, that i wish i had through my detox was the L-tyrosine.
This is a fine way to manage the buprenophine detox.
There isn't really a right way that works for everyone to detox using buprenorphine. All that matters is that they don't take a ridiculously high dose and not to use longer than necessary to avoid withdrawal (or if used long term, properly taper etc).
Using buprenorphine for acute withdrawal from oxycodone is pretty forgiving though. Basically OP needs to just take as much as she needs to feel well, once to twice a day, for a week. The details beyond that are pretty flexible, and entirely depend on the OP's specific needs and whims.
