Bupe Suboxone/Buprenorphine FAQ and Megathread v.1; 2007 - 2010

[Gum Base]

I called my doc today and told him i'm still w/d after 8mg's and he said try 12mg's or whatever I need. I gotta call him tomarrow to tell him what dose im at and if it's suficient enough. My doc is cool shit. He said take as much as you need to not w/d but it's just going to cost you more $ for the script. He knows I have no insurance and has helped me out alot by not giving me the expensive 2mg ones.
He is by far the best doctor I ever had.
He also said that it's perfectly fine that I stay on my alprazolam(xanax). which is prescribed by a different doc. I tried to get him to take over doctor position for my xanax but he said he really only deals with pain meds because he's a pain specialist for my local pain clinic.

 

[AlphaOdure]

but others want to keep you coming back for copays, so look out for those greedy bastards

Well, here in the states; doctor's are only allowed to prescribe 30 day's worth of suboxone at a time. But that was under the original legislation. I know a new statute was passed that relaxed a lot of the guidelines (including raising the patient limit from 30 to 100 per doctor, allowing for 60 day's worth of medication to be prescribed at a time, etc etc); I don't know when it goes into affect though.

BUT... the catch with this whole thing is, the doctor's who are already licensed to prescribe buprenorphine.. need to reapply through the DEA for a completely new license in order to fall under the more relaxed prescribing guidelines. So in essence, the doctor has to start all over w/ the process (from what i hear it involves a lot of legal bullshit, they gotta take a few classes, and fill out a lot of detailed paperwork on monthly basis).

 

[AlphaOdure]

^ ^ ^
Either way i know it doesn't matter. Before they passed the new statute, my buddy was given 2 - 3 months worth of suboxone at a time. So there were ways around it if you had a cool doctor. I know the first doctor i went to was an asshole though; he made me piss clean before he would put me on suboxone.

After gutting out methadone withdrawal for 5 days, i still tested slightly positive for opioids- and he STILL wouldn't prescribe me anything. Even though i visibly looked as if i was an AIDs patient on my deathbed or something (I stopped the 'done cold turkey at 90 mg- was trying to come off of IV heroin and fentanyl habit and wean myself, aacckk! didn't work, heh).

I figured i would try to get into another doctor, but that would take even longer. For some reason, all the doctors in my area (Cleveland, Ohio) waited at least 1 month after your initial "psychological evaluation" before they'd start prescribing you the medicine. I don't know if this was according to legal standards or just common practice at the time, but i ended up going to detox just so i could piss clean for this dickhead. And it wasn't one of those weekend retreats either.. I had to stay a full 8 days!

Anyways, i told the head nurse about my situation. She drug tested me on my last day to see what the results would be- i was positive for diazepam and marijuana. The valium i was given legitimately at the detox center for w/d symptoms, and i had just stopped smoking weed about 3 weeks prior so i was still showing up slightly for cannabis. The lady was really great, she wrote a letter to my doctor explaining the situation; vouched for me and said i did good and stayed clean.. etc etc.

So the asshole finally gave me the Rx! He refused to prescribe over 4 mg though, so i was still feeling sick as hell since my tolerance was disgustingly high. So I eventually ended up switching doctors anyways.

 

[biggerstronger]

I'm surprised to hear about all of this (well, actually not really. lol) I shopped around for doctors by calling each one around me and started with probably the best one around these parts. It costs me 76 dollars a month to see the doc without insurance coverage however I get the meds covered under my insurance and it costs me about 75 dollars a month per script. I get prescribed 40mg per day and he's taken over my psychiatric work as well. He also prescribed me 5mg of alprazolam for GAD and SAD. He used to prescribe me citalopram, but it wasn't working for me so we dropped it. Without insurance my scripts alone would cost about $850+ per month. It wouldn't be so bad but my wife goes to the same doc so it costs us double that. So we are still shelling out quite a bit of money for treatment. Probably cheaper than the illicit route, but I'm not too happy with suboxone. It just doesn't make me feel "right". I still have terrible cravings and I've tried every dose from 2mg to 40mg. Usually I stick to about 8 to 16mg a day. It keeps the w/d away for the most part but I've lost all motivation for everything. I honestly think methadone maintenance would be better for me, but it is way too inconvenient due to my work schedule. I am a white color worker with a rotating shift so the whole clinic situation just doesn't work for me. It sucks. I also have legitimate (never medically treated properly probably due to my fit body and age) chronic pain in my back, legs, and feet and the bupe just doesn't work for pain.

 

[thugpassion]

^To Alpha odure That is fuckin insane, Drop that fuckin asshole and find a real Dr. that will help you. My bupe Dr. Charges me 80$ bucks a vist, and writes me a script for about two months of Subutex, wich costs me alot more w/ out insurance, but there is never any bullshit when I see him. "hi. How are you", "good" Okay heres your #65 8mg. subutex, see ya next month. "okay". Find a real Dr. and not some fuckin nazi. If your paying your hard earnd money than they better recipricate. He wont scipt me benzos, but I have all the Subutex I can want for.

 

[Carl Landrover]

^
Real doctors tend to check on their patient, just because he's different than yours doesn't mean he's a shady fuck. It might end up being more costly to switch doctors or that might not be any in his area anyways.

I have to go in every 2 weeks, but it's not bad. There's a $30 co-pay, and the suboxone is fairly cheap. I've tested positive for herb everytime I've gotten tested and it hasn't affected me getting my script at all. Every doctor has different ways of doing things.

 

[chicpoena]

Wow, I must be one of the lucky ones. My doctor charged $120 for the initial appointment, and the titration appointments daily for that week were free. I saw him two weeks later and he only charged me $50. He is the coolest, most laid back and friendly doctor I have ever encountered. He's a family doctor who happens to prescribe suboxone, not an "addiction psychiatrist." He's in the business to help people, not rip them off like other American doctors.

I can't understand how doctors can ethically justify exorbitant rates, which inevitably leads to denying poor people healthcare. The health system in the US is fucked.

 

[chicpoena]

I have a question: how long do you keep the sub under your tongue for? How do you maximize absorption? Because everytime I take it my mouth fills with spit and I have to try not to swallow b/c I dont' want to swallow any bupe.

Basically, I don't understand the sublingual technique.

 

['medicine cabinet']

^i let it sit in my mouth for an hour or so...i know that seems crazy but i know 15 minutes doesnt get it all absorbed. i was told 15 mins by my suboxone dr. i know 8mgs isnt a lot of powder, but since the pill is kinda big i would think it takes longer than 15mins to get abosrbed. i know it takes 100mins for it to reach peak plasma concentration and you start to feel it afte rlike 20 mins.

im sure it doesnt take a full hour for all the bupe to get dissolved, but i figure, after that long, it all has to be absorbed.

 

[motiv311]

my doc just got my a new script for 60 8mg suboxones. and he called it in from out of state! He even talked to me for like ten- fifteen minutes about life.

You gotta understand, he knows i don't need 16 mg a day. actually i use about 2! So one bottle lasts me over three months sometimes.

I've also tested positive for Amphetamines, Marijuana, Benzos and Cocaine. And he prescribed me the suboxone even when I failed for all of these at the same time!

Basically, He is happy i no longer use heroin. And he is a very liberal doctor. I've noticed he's got track marks on his forearms. One of the nurses told me that everyone who works there (maybe 3 female secretaries and him) are all on suboxone! So they are all ex-junkies. Who better than them to help a junkie!

When I went in they didn't test me for anything, and they could tell I was withdrawing just by feeling the hair on my arms, or touching my jaw.

He can also tell if you are lying just by lookin at you!

 

[Carl Landrover]

^i let it sit in my mouth for an hour or so...i know that seems crazy but i know 15 minutes doesnt get it all absorbed. i was told 15 mins by my suboxone dr. i know 8mgs isnt a lot of powder, but since the pill is kinda big i would think it takes longer than 15mins to get abosrbed. i know it takes 100mins for it to reach peak plasma concentration and you start to feel it afte rlike 20 mins.

im sure it doesnt take a full hour for all the bupe to get dissolved, but i figure, after that long, it all has to be absorbed.

I've only been on 2 mgs for the last few months, but I always broke it up and spaced out my dosages so it didn't take so long. Even when I was on 8-10mgs a day, I'd never take more than 2mg at a time so it would break down and absorb faster.

Normally would take less than 5 minutes. Get rid of any solid feeling, then keep holding it under until the orange taste is gone, is how I do it. I don't think I'd want to be sucking on a pill for an hour.

 

[Gum Base]

I got a question when I boot up like 5 or 6mg's of suboxone what gets sucked up in the needle is all the orange shit and whats left in the spoon is some white powder that I discard. I prepare it by disolving in water no heating and let sit a few minutes to let junk go to bottom and then shoot with 50mg's of benadryl and I doesn't do much I mean I get a little bit of good feeling of well being and the only rush I get is the benadryl rush. Is this all it is? I heard not to shoot anymore than 6mg's of suboxone since naloxone is in it. Let me know thanks!

 

[mr Bungle]

im not sure if this has already been discussed but with regards to percipited withdrawl.- (my drug worker reckonmened this too) when i foolishly have been using and want to get back on my suboxone, one usually (as stated in previous posts) has to wait to your starting your withdrawls before you drop your suboxone dose as the naltraxo will fuck you up, however i find (will be different with diferent people) you dont have to wait till your withdrawling-

I was 16mg so what i did and was advised to do was just drop 4mg wait 4-6 hours before dropping anthor 4mg and so and so. The nalraxo doesnt kick your arse if you just slowly drop the 4mg wait 6hours then do it again and again. Or your could if being sensible even do it with 2mg wait 6hour 2mg more etc etc... (naltraxo does seem to be activted - or not much - when in 4mg doses in a time frame of 4-6 hours between dosing)

I find this really works does anyone else used this method???? or anything simular?

you dont have to drop all of it at once..

i still get the odd chills, but im not lying in a fetal postion, in pain in, in my own shit!

 

[eon_blue]

For what it's worth, last time I briefly stopped using my bupe for a week long dope binge, following my last dose I only waited 14 hours before starting back on my suboxone.

I took a whole 2mg tablet at once, and was pretty scared that I was going to precipitate w/d and make my situation a hell of alot worse. To my suprise (and immense relief), it alleviated the symptoms and I was good as new, relatively speaking.

Just throwing that out there that you don't necessarily have to suffer through withdrawals for 24+ hours before dosing on your bupe. Of course, this is relative to the drug you were taking before hand....in my case it was heroin. Make sure you are in withdrawals though...I was definitely feeling pretty shitty when I caved in at 14 hours.

 

[sixpartseven]

For what it's worth, last time I briefly stopped using my bupe for a week long dope binge, following my last dose I only waited 14 hours before starting back on my suboxone.

I took a whole 2mg tablet at once, and was pretty scared that I was going to precipitate w/d and make my situation a hell of alot worse. To my suprise (and immense relief), it alleviated the symptoms and I was good as new, relatively speaking.

Just throwing that out there that you don't necessarily have to suffer through withdrawals for 24+ hours before dosing on your bupe. Of course, this is relative to the drug you were taking before hand....in my case it was heroin. Make sure you are in withdrawals though...I was definitely feeling pretty shitty when I caved in at 14 hours.

Thats exactly how it goes for me. As long as you are not shooting the suboxone, you do NOT have to wait till you are in withdrawal. The nalaxone is barely active at all when taken sublingually or even if it is snorted, so you dont have much at all to worry about besides very minor urge to shit for about 10 minutes, then it passes. Thats the worst it will get.

 

[eon_blue]

Thats exactly how it goes for me. As long as you are not shooting the suboxone, you do NOT have to wait till you are in withdrawal. The nalaxone is barely active at all when taken sublingually or even if it is snorted, so you dont have much at all to worry about besides very minor urge to shit for about 10 minutes, then it passes. Thats the worst it will get.

You mean you don't have to wait until w/d at all? I know that the nalaxone isn't hardly active at all sublingually, but I was under the impression that the buprenorphine itself precipates withdrawal due to it's higher affinity.

So wouldn't taking it too soon (like within a few hours of your last dose) precipitate withdrawal too, or no? I'm too afraid and uncertain to experiment with it on myself

 

[immaturepoop]

^to me the nalaxone in the pill is just there as a scare tactic. ive shot low doses of sub and felt fine. and it isnt the nalaxone that causes the precipitated w/d's, its buprenorphine's high affinity to the mu receptors that kicks off the full agonist opiates replacing it with sub's partial agonist opiate causing the withdrawal...

edit: that was for iforgett. you have the right idea eon blue, its all about the higher affinity haha

 

[FractalStructure]

thank god you made this thing, phrozen. i mean, there are so many suboxone questions, and so many misconceptions (all i have to say is "naloxone" and "precipitated withdrawal"). also this is a drug much different than the other opiates, specifically suboxone itself not just buprenorphine. Next there should be a big and dandy CAN I SNORT XANAX thread =)

^to me the nalaxone in the pill is just there as a scare tactic. ive shot low doses of sub and felt fine. and it isnt the nalaxone that causes the precipitated w/d's, its buprenorphine's high affinity to the mu receptors that kicks off the full agonist opiates replacing it with sub's partial agonist opiate causing the withdrawal...

I've never used anything via IV, IM, or SC (i have never used a needle, and hopefully never will, but not because of the stigma... unless one day I feel like trying IM ketamine) but i completely agree. Buprenorphine competes for the receptors, and has higher affinity than even the antagonists, which i find really interesting. I dont know of any opiate with a higher affinity to these receptors. Anyway, since ive read all these stories of people successfully shooting subs, its quite apparent that the naloxone does not stop it in most cases. You would think if this is an FDA approved drug, its supposed to do all the things it is said, not that im complaining. I guess the truth is that suboxone and subutex have no difference except for headaches *possibly* caused by low doses of naloxone, but also opiates can cause headaches.

The only thing the naloxone does is, when i look at the name, i think of agonizing withdrawal. I've never even snorted subs for this reason, ive only taken them SL as prescribed cuz I dont want to risk it. Generally, is it *possible* to withdraw for someone who has been stabilized on subs for a while? it'd be nice to actually get a buzz from them... or is this one of those things where some people have gotten PWD from snorting it but others can do it just as safely as SL? Also, i know naloxone is almost inactive SL, does it have some sort of bioavailability IN? (with SL its pretty much 0% )

 

[sixpartseven]

You mean you don't have to wait until w/d at all? I know that the nalaxone isn't hardly active at all sublingually, but I was under the impression that the buprenorphine itself precipates withdrawal due to it's higher affinity.

So wouldn't taking it too soon (like within a few hours of your last dose) precipitate withdrawal too, or no? I'm too afraid and uncertain to experiment with it on myself

With in a few hours, Id assume it would. Im sorry, I forgot (its not my user name for nothin) to mention that it only happens like I describe if I wait about 16 - 18 hours before taking bupe after using another opiate.

The bupe will cause precip. WD, yes, but as I said it wont if you wait around 16 - 18 hours before taking sublingually or intranasally. You will feel minor discomforts though like having to shit a little bit and the feeling as if withdrawals are about to start, but they dont. It only lasts like that for about 20 minutes. If you shoot it, wait the full 36 hours, although I have been fine after only waiting 24 hours.

^to me the nalaxone in the pill is just there as a scare tactic. ive shot low doses of sub and felt fine. and it isnt the nalaxone that causes the precipitated w/d's, its buprenorphine's high affinity to the mu receptors that kicks off the full agonist opiates replacing it with sub's partial agonist opiate causing the withdrawal...

edit: that was for iforgett. you have the right idea eon blue, its all about the higher affinity haha

Its not ALL about the bupe though. Some naloxone is still active, even if taken directly. Its what causes the headaches in people on suboxone. You are right that bupe does have higher affinity and that naloxone is NOT the cause for precipitated withdrawals, but bupe is not just going to keep any naloxone from ever becoming active. They compete for receptors before either of them become fully active by one binding first, such as naloxone, its active for a little bit, then bupe kicks it off, and so on and so on until the bupe becomes fully active itself. You can ask others and they will agree. There was a thread recently where people were saying that even though they havent used full agonist opiates for a long time, everytime they take their next dose of Suboxone, they have minor discomforts for about 20 - 30 minutes. I think it only does that for about a half hour because of how short naloxones duration is, but dont quote me on that. Its just my theory why naloxone doesnt cause minor withdrawals for a longer period of time.

Its not a scare tactic, its true what they say, only its not the naloxone that is fully responsible for precip. WD. You have shot low dose suboxone and were fine, but how recently before doing that did you use other opiates like heroin or oxycontin? Id assume it hadnt been for a while, because even if it is low dose, you will go into withdrawal if you used recently and dont wait at least 36 hours before shooting the bupe.

 

[mr Bungle]

you, guys seem really informed. so just a quick question, when you drink alcohol and get hungover it is due to being dehydrated, so why (and other people get this) do you sometimes get a hangover type headack on herion or other opiates (im guessing with the other opiates save suboxone which i know also gives headacks)
does anyone know the biology behind these opiate headacks, Iforget you seem typically informed (if you havent forgoten) any ideas? My friend thinks its due to low sugar levels and also beleives low sugar levels (couple with bad thoughts) helps the process of being sick on canabis.

just curious, might be able to warn it off in the future if i get more info on the process.

????

just curious aswell.. is there different strength in methodone in liquid form over in the states? as in England if your on 10mg methadone tables and get put on to liquid then you get 10mls of methadone (same numbers) just that in previous posts when i have talked about mls i was informed not to and to talk in mgs as there are different strengths. Is this true?