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

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took 2 mg today and was ok most of day , now feelin shitty , its night time . took it this morning
depressed as hell
 
I am intrigued by the concept of "less is more" regarding buprenorphine. As someone who started on 16mg/day (now on 24) I had only considered tapering down for economic reasons. As the crunch continues while the assholes in government continue to trash the economy, getting by with less becomes more attractive. I might add that, when I did get the increase, I really didn't notice much difference in effect.

I've been able to get down to 8/day with surprisingly little pain, and plan to try going lower. For those of you who have done the same thing, how do you dose? Breaking 6's in half isn't much trouble, but going much lower would require using solutions, which would seem to lower the BA. Have you folks experimented with the blocking effect at reduced doses?

Thoughts?
 
Suboxone reverse OD?

Simple question for a simple man. If you overdose on an opiate will taking suboxone save you? Doesn't it kick the current opiates off your receptors thus negating the effects of the prior opiates - similar to precipated withdrawl?
 
I would have to say no. I believe what you are thinking about is naltrexone, thats the stuff they normally give people who have respiratory failture due to an overdose. Suboxone is similar in its usuage to methodone or bupe, its supposed to help you feel sober but not high, and keep the withdraws and cravings away after you deicide to kick your habit and ween yourselves off opiates all together.
 
I would have to say no. I believe what you are thinking about is naltrexone, thats the stuff they normally give people who have respiratory failture due to an overdose. Suboxone is similar in its usuage to methodone or bupe, its supposed to help you feel sober but not high, and keep the withdraws and cravings away after you deicide to kick your habit and ween yourselves off opiates all together.


Just so nobody is confused, Suboxone has bupe in it... It is bupe unless your reffering to subutex. And not to confirm what you heard but I have haerd that as well just the other day infact. I would have to say it makes sense suboxone has Bupe in it AND naloxone which kicks the opiates off your receptors before the suboxone can bind and could possibly help someone who OD's; but this is all speculation except the facts.
 
weird.

I shot 1mg subutex without filtering at a very low tolerance in the morning. Around 12 I was sober at around 4 which is way too short for a subutex high. Then I shot another 1mg subutex at 5 and was intensley high again which only lasted 2 hours again the shot was not filtered. I don't understand subutex has always been long acting even when IV'ed for me and I had a low tolerance why did I sober up so quick? I might as well get some good h which would of lasted around the same time with a rush. What is subutex IV half-life? I am very confused as the high started very strong like always but did not last.
 
I am new to Bluelight but have read just about everyones post on Suboxone. Many people state you must wait at least 24 hours to start your Suboxone treatment. I just wanted to add my experience. I have been addicted to opiates for almost 8 yrs. Started with vicodin and gradually increased to oxy's, fentanyl and occasionally a good bag of dope(never injected). My habit the past two years had been at least 2/80 mg Oxy's, 10-20/10mg percocet and 4-6/30 mg morphine sulfate pills a day. I indulged in perscriptions of Fentanyl and whatever else I could get my hands on during this 2 year binge in addition to the above. This week, even though I have legitimate chronic pain issues and can obtain perscription of any opiates I need, decided I was done running after the high. I had read that suboxone can also be used as a chronic pain med. All I had to do was look on the suboxone website and call a doctor(read alot about people having to wait extremely long times). I had my first appointment this past monday. I continued with my habit up until the day of the doctors visit. In the morning when I awoke I was sick. I snorted one 30 mg tablet of morphine to stop withdrawls at 10:00 in the morning. My appointement was a 2:00. I reviewed everything with the doctor and was open about my usage and my medical problems. I was given 60 tablets and instructed to take 16mg a day. I waited until 8:00 to take my first dose. I was not in withdrawl except for a runny nose/back pain. With in a hour I felt energetic and all signs of sickness where gone. I did not experience early withdrawl or I guess PAWS.
 
The half-life should be the same regardless of the ROA I think, if we're talking strictly about the ability of your liver to metabolize the drug. The difference between IV and other ROAs is that since the drug hits you all at once, it should all get to the liver more quickly and thus actual metabolism will tend toward the shorter end of things, but the half life should still be 24-36 hours.

You probably sobered up quickly due to either situational tolerance (likely, if you're repeatedly doing your shooting in the same place and doing the same activities each time), whereby your brain basically knows what to expect, and so you dont feel subjectively as high as you did before, or simple tolerance via the brain or perhaps an induction of metabolism of bupe in the liver (which I'm not sure bupe does, its a wild-assed guess). But my guess is that shooting it is slowly raising your tolerance, and now that you know what to get out of the shot, you dont feel as high for as long.
 
Ok, so a couple of weeks ago my dealer went away for an extended period of time. Prior to that I have been considering quitting (or at least taking a long break from) opiates anyways. I ended up just sucking up the withdrawal, while managing to get a couple of things to help me through it. I used a little bit of codeine last night, but that was the last of what I had.

Even though physical withdrawal has stopped, I really want to get on bupe because I still feel very depressed without the opiate high.
My question is, are they going to drug test me to verify that I have opiates in my system before putting me on bupe? By the time I see the doctor my pee will probably be opiate free and I don't want to not get put on bupe because they think I am lying about having a problem or something.

I feel like this question sounds sort of stupid, but I need to know before making the appointment tomorrow.
 
Some, but not all suboxone docs use drug-testing. I've had both. You should go into it without secrets if you are serious about getting straight.
 
I shot 1mg subutex without filtering at a very low tolerance in the morning. Around 12 I was sober at around 4 which is way too short for a subutex high. Then I shot another 1mg subutex at 5 and was intensley high again which only lasted 2 hours again the shot was not filtered. I don't understand subutex has always been long acting even when IV'ed for me and I had a low tolerance why did I sober up so quick? I might as well get some good h which would of lasted around the same time with a rush. What is subutex IV half-life? I am very confused as the high started very strong like always but did not last.



why on earth are you shooting subutex without filtering it , thats so bad for you
 
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Some, but not all suboxone docs use drug-testing. I've had both. You should go into it without secrets if you are serious about getting straight.

I have no problem being honest with the doc, as long as they aren't going to think I am making anything up just to get subs or something. Thanks for your help.
 
I would have to say no. I believe what you are thinking about is naltrexone, thats the stuff they normally give people who have respiratory failture due to an overdose. Suboxone is similar in its usuage to methodone or bupe, its supposed to help you feel sober but not high, and keep the withdraws and cravings away after you deicide to kick your habit and ween yourselves off opiates all together.

You are actually thinking of Naloxone.

Naltrexone is similar, but has a longer half life, (one of the reason's it isn't used often for overdoses, but would still work) and is used more often for rapid detox.
 
when i went in i got drug tested but the doctor still used the NIDA 5 test. i told him i used oxycontin, fentanyl. when the test came up negative the doctor didnt give me a diff test he just assumed what i said was accurate. but then i relapsed within the 1st week n i told him about it and he said he would start drug testing me on my visits which makes me wonder even if he did test me would get the standard NIDA 5 or a specific oxycodone test. i made sure i was clean for my 3rd visit but he didnt even do either test soo oh well it looks like i am just gonna make sure i am clean each time to be on the save side, sorry to ramble but that is my account with bupe docs n drug tests
 
The OP isn't thinking of another drug, he's just wondering if the precipitated withdrawals caused by Bupe due to it's partial agonist/antagonist profile would be enough to pull someone out of OD, since it is replaced whatever opiates are on your receptors currently

It seems logical to me, but maybe djsim can shed some science on the subject
 
The buprenorphine in suboxone/subutex is a partial agonist at the mu opioid receptors and WILL block any further opiate intake. The naloxone, true, is an opioid blocker, BUT it is not active in the product when you take it sublingually. It's there as a deterrent if you were to inject it IV or IM. It would prevent a high from injecting the buprenorphine. It does NOT work when taken orally, only IV or IM.

Buprenorphine will also kick off any current opioids you have in your body, which is why the MD won't put you on it until you are in mild to moderate withdrawal, or it will produce a NASTY withdrawal. And if you've been taking the suboxone for a while for maintenance and you decide to inject it, not only will it have no high effect, but any buprenorphine that was currently there working will be kicked out by the naloxone, also resulting in a nasty withdrawal.

Also, buprenorphine has a "ceiling effect" which means it can only create so much of a high before it hits a limit. If you took 20 or if you took 40 buprenorphine tablets, the 40 would give no greater effect than the 20 did because of this ceiling effect.

But would I recommend taking Suboxone sublingually to combat an opioid overdose? Probably not. I think it may be effective, but I have yet to come across studies validating that. The mainstay is IV naltrexone or naloxone to reverse OD from opiates.
 
I also found this reference if you're interested. I put in a section of it that tells of a guy who was abusing heroin and then decided he wanted to get clean again, and he took 40 mg buprenorphine and had severe withdrawal for 3-4 days.

"We report a patient enrolled in buprenorphine maintenance treatment. At enrolment he was 35 years old, with a 10-year history of heroin use, poorly controlled asthma, and features of depression and anxiety. He started taking buprenorphine at a dose of 8 mg per day, increasing to a maintenance dose of 24 mg daily within three weeks. Consecutive weekly urine samples over six months indicated no heroin use.

After 12 months of continuous therapy, his buprenorphine dose had reduced to 16 mg every second day, and was continuing to be gradually reduced. At this time the patient's long-term relationship ended, he started drinking alcohol heavily and recommenced heroin use. Unbeknown to pharmacy staff at the time, he was not routinely taking his buprenorphine as directed; instead, after dosing he would leave the pharmacy quickly, spitting out the tablets before they had dissolved. In this way he saved 11 tablets (8 mg each).

After several weeks of regular heroin use without taking buprenorphine (although still attending the pharmacy and continuing to accumulate buprenorphine), he decided to re-initiate treatment of his own accord with the accumulated buprenorphine tablets. He took 40 mg buprenorphine at once, which precipitated uncomfortable opiate withdrawal symptoms (agitation, nausea, sweating, abdominal cramps) within an hour of ingestion. In an attempt to relieve the withdrawal discomfort, he then took a further 24 mg, but this provided no relief. He took a further 16 or 24 mg, but continued to experience persistent agitation, poor sleep, abdominal cramps, diarrhoea and sweating.

The patient presented to the clinic two days later. He appeared restless and agitated and was requesting more buprenorphine. He was dispensed 16 mg buprenorphine, but continued to experience symptoms of opiate withdrawal overnight, despite using heroin. The next morning, still appearing agitated, tense and distressed, he told treatment staff what had happened. He was subsequently transferred to methadone therapy, with resolution of his withdrawal discomfort.

Discussion
This case highlights a number of features of buprenorphine's unique pharmacology which are pertinent to healthcare providers. Firstly, it shows the relative safety of buprenorphine in very high doses. This patient took 88 mg of buprenorphine within one day — almost three times the maximum recommended daily dose (32 mg). This is consistent with another reported case of massive buprenorphine overdose, in which 112 mg was taken orally, also without significant respiratory depression.2 This safety is due to the ceiling effects of buprenorphine in high doses.

Secondly, rather than experiencing features of opiate overdose (eg, respiratory depression, sedation), our patient experienced precipitated opiate withdrawal. When buprenorphine is taken soon after opiates with less opiate-receptor affinity, such as heroin and methadone, it displaces them from the receptors. Since buprenorphine is only a partial agonist, this causes a drop in the level of overall opiate activity and is experienced as opiate withdrawal. While we are aware of only three other reported cases of buprenorphine-precipitated withdrawal after heroin use,3,4 it is common in methadone patients transferring to buprenorphine therapy, particularly with higher doses of methadone (> 40 mg), a short time between the last methadone dose and the first buprenorphine dose and when higher initial buprenorphine doses are used.5-8 Withdrawal symptoms typically commence within 1–3 hours of the first buprenorphine dose and can last for several days."

Med J Aust. 2002 Feb 18;176(4):166-7.
Severe opiate withdrawal in a heroin user precipitated by a massive buprenorphine dose.
Clark NC, Lintzeris N, Muhleisen PJ.
 
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