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

[Opiyumphile]

Other than Diarhea (something I would pray for while on maintenance really) I've experienced all of those side effects and I wasn't dope sick.

 

[Captain.Heroin]

(7) Suboxone

Each tablet also contains lactose, mannitol, cornstarch, povidone K30, citric acid, sodium citrate, FD&C Yellow No.6 color, magnesium stearate, and the tablets also contain Acesulfame K sweetener and a lemon / lime flavor.

http://www.drugs.com/pro/suboxone.html

( Subutex

Each tablet also contains lactose, mannitol, cornstarch, povidone K30, citric acid, sodium citrate and magnesium stearate.

http://www.drugs.com/pro/suboxone.html

Povidone K30:

I found out that this is soluble in cold water from the link below.

http://www.sciencelab.com/xMSDS-Polyvinylpyrrolidone_K_30-9926650 <-- Povidone K30 Material Safety Data Sheet

It appears to be a skin, eye, and respiratory tract irritant.

This is a common reason why both Suboxone and Subutex can both cause GI tract problems. It is the nature of buprenorphine and other opiates to do this anyways, but the inactive ingredient Povidone K30 is what I believe causes GI tract problems. It is in both Suboxone and Subutex.

 

[ruffneck81]

captain heroin,

i found this on another forum, and i wanted your opinion. just to let you know i simply want to make sure that this statement is correct, and that you agree. now i have to get back surgery at some point, and also i was hooked on over 600mgs. of oxy per day. i switched to suboxone 2 weeks ago...im prescribed 24mgs per day, but after a few days of hell i got down to 8 to 12mgs per day. my concern is this...would it be ok for me to take say a 60mg oxycontin after about 4 hours from my last bupe does of 8mgs? im not looking to get high... id need alot more then 60mgs, but my primary interest is would the added oxycontin help with my pain? then the next concern is can i then resume my bupe dosing say 8 hours later, i do not ever want to go back into p.wds. it was hell in the beginning. i do great on suboxone however i really do not agree that it is a good pain med...maybe oxycodone added to bupe may help my pain, and then also help me not to take huge amounts of oxy because the life of bupe is so much longer.


this is what i read somewhere else:
Any full agonist can be added on top of suboxone (going the other direction will kick off a a very nasty incident of precipitated withdrawal) So, once you're "on" sub, oxycontin, morphine, etc. can be added on top of it for added pain control. Fentanyl is often used because it is so potent. The reason you can go in one direction but not the other is buprenephorine's high affinity for the Mu receptors. If you give it to a patient on a full agonist without waiting long enough, or if the patient is on a dose that is too high, then you're going to knock the morphine or fentanyl off the mu receptors which can be risky in situations when someone is on a high dose of meds. If a person is on sub or bupe, some of the receptors will be unoccupied. The full agonists won't knock bupe off the mu rececptors, but they will attach to unoccuppied receptors

 

[ruffneck81]

I live in Taiwan (though I'm originally from the UK), and over here buprenorphine is prescribed only in the form of sublingual Temgesic tablets. I've read that the patches are preferred these days for chronic pain, with the sublingual tablets being used more for breakthrough pain. I suspect one reason is the potential for abuse with the tablets (which are very easy to grind into a powder) and also because the patch formulation is considered more smooth and sustained by many doctors (apparently the tablets can cause more CNS effects, as they are absorbed faster).

I don't know for sure about the analgesic ceiling effect. I have read in numerous studies that none has been demonstrated in humans, but I get the sense that it is a bit of a 'grey area'. One study I saw showed that at 16mg buprenorphine binds 80% of available mu-receptors, as opposed to about 40% at 2mg. That would seem to suggest to me (admittedly, a complete non-specialist!) that there may be little point in continuing to escalate the dose beyond a certain level.

Likewise, I don't really know what the limits for safe, effective analgesic doses are. I know that the suggested analgesic dose is 0.2-0.4mg, but my pain management docs here in Taiwan and back 'home' in the UK confirmed that the dose range for pain relief is quite flexible, and they had no problem prescribing three of the 0.4 mg tablets for me to be taken three times a day. I would expect that the dose needed would vary from person to person, but I don't know for sure what the limits are in terms of safety with other opioids.

According to the sources I've consulted (my doctors and various published studies) and the info that comes with my Temgesic prescription, it is safe to take buprenorphine in the therapeutic analgesic dose range at the same time as other opioid agonists, also in the analgesic dose range (for breakthrough pain, for example), and I've also read that the order of administration of the buprenorphine or the other opioid is irrelevant. That is my understanding, but I don't know at what point, if any, problems may be expected to arise, regarding the dosage of either opioid (or both). I do know that it is not recommended that a patient already dependent on high doses of another opioid add buprenorphine to the mix, as there is a possibility of dulling the effect of one of the opioids, or even of precipitating withdrawal. I think this is most likely to occur in people taking a lot of opioids and then adding a high dose of buprenorphine, but I don't know what doses, precisely, would be expected to cause such an interaction.

I was prescribed Temgesic after trying dihydrocodeine and tramadol for several months (neither were effective on their own in controlling my pain), and I didn't have any problem switching from one to the other. I don't know if it would have been different if I'd been on higher doses for a longer period, or if I'd started off with a higher dose of buprenorphine. From what I've read, I'd guess that it could have been a problem if I'd been taking the kind of dose found in Suboxone or Subutex, but I can only speculate. Sorry to be so vague!

Regarding the high doses used in Suboxone/Subutex, I honestly don't know - I know next to nothing about the role of buprenorphine in treating opioid dependence. The doses do seem very high to me, especially the higher range of 16mg to 32mg.

Sorry I can't be of more help - I know everything I've posted here is pretty vague, but my own knowledge of buprenorphine (such as it is) is strictly limited to my own experience and I'd hate to give unfounded advice that may be harmful to someone else. Good luck!

 

[johanneschimpo]

(answer for 2 posts up) I doubt you'll feel much, if anything, from taking 60mg oxy on top of 8mg bupe. In lower doses, generally accepted to be ~2mg or less, full agonists will have some effect on top of bupe, but at a higher dose like 8mg you can expect any oxy/other full agonist you take to be mostly if not entirely blocked.

 

[Captain.Heroin]

captain heroin,

i found this on another forum, and i wanted your opinion. just to let you know i simply want to make sure that this statement is correct, and that you agree. now i have to get back surgery at some point, and also i was hooked on over 600mgs. of oxy per day. i switched to suboxone 2 weeks ago...im prescribed 24mgs per day, but after a few days of hell i got down to 8 to 12mgs per day. my concern is this...would it be ok for me to take say a 60mg oxycontin after about 4 hours from my last bupe does of 8mgs? im not looking to get high... id need alot more then 60mgs, but my primary interest is would the added oxycontin help with my pain? then the next concern is can i then resume my bupe dosing say 8 hours later, i do not ever want to go back into p.wds. it was hell in the beginning. i do great on suboxone however i really do not agree that it is a good pain med...maybe oxycodone added to bupe may help my pain, and then also help me not to take huge amounts of oxy because the life of bupe is so much longer.


this is what i read somewhere else:
Any full agonist can be added on top of suboxone (going the other direction will kick off a a very nasty incident of precipitated withdrawal) So, once you're "on" sub, oxycontin, morphine, etc. can be added on top of it for added pain control. Fentanyl is often used because it is so potent. The reason you can go in one direction but not the other is buprenephorine's high affinity for the Mu receptors. If you give it to a patient on a full agonist without waiting long enough, or if the patient is on a dose that is too high, then you're going to knock the morphine or fentanyl off the mu receptors which can be risky in situations when someone is on a high dose of meds. If a person is on sub or bupe, some of the receptors will be unoccupied. The full agonists won't knock bupe off the mu rececptors, but they will attach to unoccuppied receptors

This sounds about right.

The idea why you really don't want to take buprenorphine, and then oxycodone (or another full agonist) only hours into the first dose of buprenorphine is the idea that a certain percentage of receptors that are going to be completely saturated with the buprenorphine and nor-buprenorphine. So, whatever percentage of receptors you have left is what can be effected by the full agonist. However, the affinity of buprenorphine to the mu-opioid receptor is much higher than the affinity of oxycodone to the mu-opioid receptor. This means, if you're on a "high enough" dose of buprenorphine, the oxycodone you take while on buprenorphine may not be felt...at all.

Some people have to wait days after taking buprenorphine until they can "feel a mu-agonist again"... however this is probably variable from individuals. Personally, I can take buprenorphine in the morning and heroin by night, but I wouldn't prefer that (it would be better to wait a whole day and then use) and I don't use heroin anymore, so I can't really tell you.

Some people could take buprenorphine and within a matter of 4 hours they could take a mu-agonist to some effect. I'm not one of these people. And I don't know if, for you, taking the oxycodone after the buprenorphine, in the same day, would be worth it or not for any degree of pain relief. It's something you'd have to try and find out, really. I'm sure some people would get excellent analgesia from this while others would feel disappointed from the lack of effects.

If you do decide to try it, good luck, and let me know if it was worth it.

(answer for 2 posts up) I doubt you'll feel much, if anything, from taking 60mg oxy on top of 8mg bupe. In lower doses, generally accepted to be ~2mg or less, full agonists will have some effect on top of bupe, but at a higher dose like 8mg you can expect any oxy/other full agonist you take to be mostly if not entirely blocked.

Sadly, I think you're right JC.

Someone with a super-high opiate tolerance may only get so much out of 8mg that it might work for them, but I couldn't say, I haven't been there myself.

 

[ruffneck81]

thanks alot for the reply, i really appreciate your knowledge.

in my situation i have to say that im glad i got on suboxone, however now the pain is a big issue, and im going to have to stick it out. soon as i have my surgery ill just have to quit the suboxone. im definetly going to try it once so that i can record my own results, i know that my induction into suboxone was hell, i waited 22 hours, and i was in absolute hell for 4 days, i was at the brink of insanity, i absolutely have never in my life gone through something as painful as the precipitated wds.

as long as i keep some bupe in my system, i will not go into pcp wds right? if i decide to take a dose of pain meds maybe at night for bed time. i just dont want to go back to were i was, the first time i took suboxone scared the shit out of me, had it not been for a friend of mine i probably would still be nodding off all day long. i cannot believe i let myself get so bad. i remember when jack osbourne was on oxycontin, and i said ill never do that...yea right i dont even know how in the hell i got to were i was so fast. its like i was on the concorde. eitherway im going to try and take my pain meds at night one time, no huge dose just normal, and see what happens, and then take a small dose say 2 to 4mgs of suboxone in the morning. i can truly say that suboxone has saved my life.

 

[Captain.Heroin]

thanks alot for the reply, i really appreciate your knowledge.

in my situation i have to say that im glad i got on suboxone, however now the pain is a big issue, and im going to have to stick it out. soon as i have my surgery ill just have to quit the suboxone. im definetly going to try it once so that i can record my own results, i know that my induction into suboxone was hell, i waited 22 hours, and i was in absolute hell for 4 days, i was at the brink of insanity, i absolutely have never in my life gone through something as painful as the precipitated wds.

as long as i keep some bupe in my system, i will not go into pcp wds right? if i decide to take a dose of pain meds maybe at night for bed time. i just dont want to go back to were i was, the first time i took suboxone scared the shit out of me, had it not been for a friend of mine i probably would still be nodding off all day long. i cannot believe i let myself get so bad. i remember when jack osbourne was on oxycontin, and i said ill never do that...yea right i dont even know how in the hell i got to were i was so fast. its like i was on the concorde. eitherway im going to try and take my pain meds at night one time, no huge dose just normal, and see what happens, and then take a small dose say 2 to 4mgs of suboxone in the morning. i can truly say that suboxone has saved my life.

I'm glad to hear suboxone helped you get away from oxy. I am past the 9 month sobriety point in my recovery from heroin, I'm pretty proud of myself to be honest as well.

 

[cire113]

I dont know why i feel so guilty taking suboxone... its mostly because my family thinks its the same as heroin....

The good news is ive tapered down to .5mgs of sub 2x a day...

the bad news is i still have 1,000mgs of sub left......


I know pretty dam well im not gonna stop taking this stuff if i have 1,000 mgs left...

But honestly is eating subs in the long term really all that bad?(It seems i use it as antidepressant)

It is definetly better than sticking aneedle in my arm 4x a day

 

[Northside]

Well, I went to the clinic yesterday - to have a talk with a more exoeriance doctor about getting help with my Subutex reduction.

I've got down to 1.2mg, but was waking up in WD at around 4am everyday. I put myself onto daily pickup so I wouldn't start eating into my pills. But t still isn't nice starting each day with 5 hours of WD before I could get my dose then go to work.

I started to find that it was effecting my mood during the day ass well, as I KNEW that it wouldn't be long before I was in bed shaking and sweating :/ .

Anyway, the doc was actually quite good. My first suggestion was clonidine/Lofexidine. He agreed that this was a good idea, but said it would require my blood pressure be checked everyday. Given the distance between me and the clinic at the moment (summer uni break) this is VERY difficult.

We decided to continue with my reduction schedule - but he has scripted me 40mg Diazapam for the first couple days of a reduction. He has also scripted me Mirtazipine to be taken every night. Hopefully these two will take the edge of the WD's and make it a bit more bearable.

What do you guys think? Anyone here ever use mirtazapine to help sleep?

I know the benzos will definitely help the first couple days of a subutex reduction when the WD is at its worst.

The doc said that if this doesn't work, he will talk to my pharmacy - and se if they would be OK with taking my blood pressure. I get on with them very well, and see them every day so I can't see it being too much of an issue. They have often said that they can see I'm making a real effort with this..

808- it sounds like you're gonna be off this stuff soon! Those other meds will be just the ticket to get you through the last of your taper- rock on man!

I've stayed off them for a while now , couple months? Anyway I have been using , like a weekend warrior. I know it's bad but it's not as bad as weekend warring AND having a sub habit.

Everyone else- just stick with it, it's worlds better than managing a dope habit.

 

[Eight0Eight]

^ Its funny you should reply to this today!

I just got back from the clinic.

I dropped the Mirtazapine, as it wasn't really making me very sleepy but was making my speech all slurred. several people mentioned it which means it must of been bad as they hadn't said anything when I was full-blown into smack!

The Diazapam has *really* helped. I couldn't thank them enough for that. I'm getting scripted 20mg for just the first 2 days of every weekly reduction. It really helps me in the morning when I wake up in WD at 4am. It doesn't really get rid of much of the physical side - but it certainly helps with the anxiety and restlessness. I can just lie there and relax or go online and chil and not keep on looking at the clock every 2 minutes.

Even better - I don't take the full 20mg. I find 10mg is enough. I've never got a "high" from the stuff - just use it as a tool really. If I can get all the way down to nothing and not use more than 20mg diaz 2 days a week I'll be happy!

Having said that, I did score some H. But today I just got 3 bags (and gave one to a mate). This is a real bg thng for me as I normally go mental and get an 8th.oz.

Right now I'm at 1mg sub. I think I can do this.

You have been using? Do you think you can do that indefinitely (chip) I don't think I could. Do you have any sub left? It might be an idea to just try using a small amount of that instead of proper gear when you get the cravings?

 

[ruffneck81]

ok cap got a quick question.

just to let you know i have been taking 8 to 12 mgs per day of suboxone two to three 4mg doses. i took my last dose at 12pm today. i plan on taking 30mgs of ir oxycodone tonight at 9pm for reasons of a drug test at my pmd.
so im extremely paranoid that im going to get sick from this, ive been through pcp wds and it was the worst experience of my life. my question is this will I GET SICK if i take 30 to 60mgs of oxycodone 9 hours after my last suboxone dose, and then in the morning 14 hours after my oxy dose take 8 mgs of suboxone? i am not trying to get high at all, just need a concentration in my system for the dt. i know this has been covered, but i want your thought and opinion on this matter in particular, i really appreciate it.

 

[Eight0Eight]

^ You won't get sick from taking opiates AFTER you have taken bupe.

They just won't work. Especially if your on 8-12mg a day. You wil have to have to wait a little longet than that.

I once got a nod after ahooting a HALF GRAM of really good smack just 14 hours after taking 12mg subutex. But 30mgs oxy I doubt would do anything.

 

[ruffneck81]

thanks for the reply...so i will not get sick, or feel it...which is good. but my concern will be 14 hours after i take the 30 to 60mgs of oxycodone. will i get sick from taking suboxone tomorrow morning if i take oxycodone ir tonight. i know you can do it one way but not the other way. see i dont want to get back on the oxy totally just need to take it once for dt.
this shit scared me somewhat i guess not having experienced anything besides extreme wds.

 

[Eight0Eight]

When I relapse, I make sure I continue taking my bupe as normal the next day.

I am on a very small dose though (1mg/day). I would hesitate to take 8-12mg whilst there is still proper gear in your system .

However, If you choose NOT to wait before taking the oxy, I doubt your next dose of bupe will make you feel sick, as the oxy wouldn't have stuck to many (if any) receptors.

If I was in your posistion (and really wanted to use oxy), I would wait 'till I started feeling sick, take the oxy, then wait until I felt sick again before dosing more bupe - perhaps only dosing 2mg of bupe to start with, then 2 more a couple hours after if you felt OK.

The day after that, I would go back to yur normal dose of sub.

 

[ruffneck81]

thanks for the insight, i really appreciate it. i know everyone is different, so ill see how it goes. i just have to take some oxy for my D.T.

THANKS

 

[Eight0Eight]

No worries mate!

I'm glad my dubious misadventures could actually be of some use to somebody else ! 8(

 

[ruffneck81]

well i took 60mgs of oxy after 12 hours of suboxone, and no effect at all. nothing 0 zilch null garnichts....
all im hoping for now is that i dont get sick in the am taking 8mg's suboxone. im really hoping. ill let you all know.

 

[Captain.Heroin]

I dont know why i feel so guilty taking suboxone... its mostly because my family thinks its the same as heroin....

The good news is ive tapered down to .5mgs of sub 2x a day...

the bad news is i still have 1,000mgs of sub left......


I know pretty dam well im not gonna stop taking this stuff if i have 1,000 mgs left...

But honestly is eating subs in the long term really all that bad?(It seems i use it as antidepressant)

It is definetly better than sticking aneedle in my arm 4x a day

If you have 1G of buprenorphine left, do you have 125 of the 8mg pills, or 500 of the 2mg pills?

It sounds like your family is ignorant if they think it's the same as heroin. I wouldn't feel guilty about taking suboxone at all. I mean, do you feel guilty about using heroin?

Buprenorphine is a really efficient antidepressant. I would keep tapering lower if possible, this will help the antidepressant effect out as you keep supplementing your own natural endorphins as your dose lowers.

ok cap got a quick question.

just to let you know i have been taking 8 to 12 mgs per day of suboxone two to three 4mg doses. i took my last dose at 12pm today. i plan on taking 30mgs of ir oxycodone tonight at 9pm for reasons of a drug test at my pmd.
so im extremely paranoid that im going to get sick from this, ive been through pcp wds and it was the worst experience of my life. my question is this will I GET SICK if i take 30 to 60mgs of oxycodone 9 hours after my last suboxone dose, and then in the morning 14 hours after my oxy dose take 8 mgs of suboxone? i am not trying to get high at all, just need a concentration in my system for the dt. i know this has been covered, but i want your thought and opinion on this matter in particular, i really appreciate it.

Hm, I'm not sure. I don't know how long it takes a drug to show up in a drug test, so I don't know if it would work. You probably do, so I'll answer the first question: yes, it should be fine to take oxycodone 9 hours after your last dose of suboxone. I've used heroin 8 hours after my last dose of buprenorphine (albeit a much smaller dose than yours) and was fine.

I don't know how great of an effect it will give you, but there shouldn't be any negative effect.

You can also take the buprenorphine the next day if you're not feeling the OC anymore. I would make sure it's not in your system by waiting until you get the icky feelings of WD until switching back to the buprenorphine.

If it will be 14 hours later, you should be fine. That sounds like it'd be long enough. I don't use OC's, never even seen a brand name OC my whole life IRL, so I can't say for sure. But if you're certain the effects would be gone 14 hours later, you'll be just fine.

No worries mate!

I'm glad my dubious misadventures could actually be of some use to somebody else ! 8(

hahhaha i love it when people post the 8( face!

well i took 60mgs of oxy after 12 hours of suboxone, and no effect at all. nothing 0 zilch null garnichts....
all im hoping for now is that i dont get sick in the am taking 8mg's suboxone. im really hoping. ill let you all know.

Good luck man! I'm going to guess you'll be just fine.

It might be wise to, in the AM, split your 8mg pill up in quarters and start with one. If you do get precipitated WD, it'd be a lot better to only take 2mg instead of 8mg.

Plus, if you take the 2mg, and feel everything is OK but know you need more, you can always take more.

 

[Northside]

No worries mate!

I'm glad my dubious misadventures could actually be of some use to somebody else ! 8(

Not in response to this post but to a few back, no I don't think I can chip indefinitely. I'm still getting my scripts and have plenty to fall back on if need be.
I just feel a whole lot better not taking the subs. They are an excellent drug but after a few months they made me very depressed and disinterested in life. Now I feel like myself again, I want to do things and I enjoy myself and my life.

Looking back, I probably just stayed on them longer than I needed to and that's when they started to have a negative impact. If I end up on them again, now I'll know to get off them before they start making me worse instead of better.