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

[Abbath]

It's going to take too long to kick anything off the receptors to help out. Your "patient" will be dead before the suboxone reaches the brain if they've seriously overdosed. PLEASE anyone who sees an overdose, just suck it up and get the person medical care ASAP, you don't want to be responsible for someone's death.

 

[Dankycodone]

Optimus and leftwing. I know how bad shotting pills are plus not filtering that was not apart of my question I just stated that so you guys know there was no loss of product. I preach about the saftey of using micron filters so you don't gotta tell me.

 

[Captain.Heroin]

buprenorphine

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.

Naloxone is inactive even if you IV it. It is not advisable to IM pills under any circumstances.

As for this...

The buprenorphine in suboxone/subutex is a partial agonist at the mu opioid receptors and WILL block any further opiate intake.

I disagree.

It's dose dependent. If you dose < 4mg, it is likely you can still get high with something like good quality powder heroin (or another high potency opiate). It is when you are dosing 8mg + (in some people much more) where the "blockade effect" which is equivalent to (subjectively - I have never done methadone) 80mg methadone's "blockade effect".

However, precipitated WD's only work going one way: heroin/morphine/oxy/other opiate of choice, and then using buprenorphine. If you use the buprenorphine before the other opiates have more than fully worn off, then precipitated WD's occur. If you use buprenorphine, and then take something like codeine/oxy/morphine/dilaudid/heroin, etc, you won't experience precipitated WD's. There even be nice synergism depending on the ratio of how much of one drug to the next, and also on the dose of buprenorphine being low enough so that you have enough mu-agonist receptors open still.

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.

That's not true at all. That's just lies that were told by R&B to the FDA and doctors.

The mainstay is IV naltrexone or naloxone to reverse OD from opiates.

This is true.

Buprenorphine can also repress your breathing heavily. Especially if the OD is from a combination of CNS depressants other than opiates (alcohol, benzos, etc), using buprenorphine in the case of an OD may not help you. Plus, the effects will be probably more unwanted than just an antagonist, but I haven't been in either scenario so I really couldn't verify that.

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.

Buprenorphine has a better affinity to the mu-opioid receptor, meaning, it out-competes naloxone for the receptor. This renders Subutex and Suboxone to be the same in most people (very few people are 'allergic' to naloxone).

If you take buprenorphine (either through Subutex or Suboxone) soon after you took regular mu-agonists, it is the buprenorphine which will dislocate the full mu-agonist from the receptor.

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

It depends on if the individual is overdosing on just opiates, or a combination of opiates + another downer, or opiates + a stimulant, etc. Adding buprenorphine on top of stuff like a large dose of benzos can be very disastrous in terms of if you were already ODing, because the extra respiratory depression can be dangerous.

If you only do something like IV heroin and you didn't do a test shot and your normal 4 shot bag had your lips turning blue...then it is possible buprenorphine may dislocate enough of the short-acting opiate - and it is likely your opiate tolerance is high enough so that the buprenorphine won't too heavily worsen the breathing rate, BP, etc.

So, all in all, in most cases, it's a lot safer to have a pack of needles and a vial of naloxone on hand. If you're able to IV and if not, IM naloxone can save lives if used properly and only when necessary.

DJSim isn't the only one here to shed light on such subjects - tons of other mods are very enlightened and there's always the chem/bio brains in ADD too. However, I am interested in hearing anything he has to add for sure. He is a very knowledgeable person and may be able to point out why this is a bad idea more so than I am currently.

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.

Buprenorphine will begin to antagonize itself at the receptor at high to extremely high doses. This case is a good example.

This is why it's always best to dose as low as possible with buprenorphine, so you can get the best results from it.

It's going to take too long to kick anything off the receptors to help out. Your "patient" will be dead before the suboxone reaches the brain if they've seriously overdosed. PLEASE anyone who sees an overdose, just suck it up and get the person medical care ASAP, you don't want to be responsible for someone's death.

Yes, this is also a very good point - sublingual Suboxone is very, very slow acting compared to an intramuscular or intravenous shot of naloxone.

I also forgot...

-> Suboxone Mega Thread & FAQ

 

[KnowBudz]

There sure are a lot of repetitive questions about suboxone!

 

[BiggDirty01]

2 Week Eval for Pain MGMT

Hey guys,

wondering if any one else out there has had a PM Doc who ordered a 2 week subutex evaluation/taper to evaluate pain levels minus narcotics? I was on Roxy 30mg x up to 6 per day. Im currently in my first day of Sub use (what a fun 24hrs that was waiting!

Anyway wondering if there others out there that have PM Docs that use Sub/taper in order to reevaluate PM needs for the future?

BD

 

[Georgie25]

I got a sub questionnfor you guys. I been taking about 3mg of subs a day since monday this week and am really just trying to wait it out until I get paid this friday the best I can, constantly thinking about getting high of course..Last week I blew my whole check within the weekend so this time I'm gonna use once then save the rest for thruout the week and not just binge nonstop on it.

But my question is, what day should i stop taking my subs to feel the dope real good on friday? Could I take it thursday morning around 11 and have it out of my system by 1p.m the next day? I've only been using subs to help the w/ds and have only been on them for 3 days so far, so would this have any signifcant effect? Thanks.

edit- I should add that i dont have a script for these subs. I only have 4 1/2 left anyway. I also always IV my heroin if that matters.

 

[Captain.Heroin]

Hey guys,

wondering if any one else out there has had a PM Doc who ordered a 2 week subutex evaluation/taper to evaluate pain levels minus narcotics? I was on Roxy 30mg x up to 6 per day. Im currently in my first day of Sub use (what a fun 24hrs that was waiting!

Anyway wondering if there others out there that have PM Docs that use Sub/taper in order to reevaluate PM needs for the future?

BD

I would've just gone to a new doctor (if you didn't want to try buprenorphine).

To be honest though you should be trying this out. I only say this because if Subutex can help allevaite your pain, it is less likely you will grow a tolerance using Subutex, and a lot more likely you will grow a tolerance to oxycodone.

If you do need oxycodone, then you should be able to get back on it.

Give the buprenorphine a chance, if it treats your pain well see if you like it better - I prefer the long term use of buprenorphine more than heroin, and I would prefer buprenorphine a lot more than things like oxycodone or morphine, etc.

Also, worst case scenario, you save the Subutex for a rainy day and you find other opiates to hold you the 2 weeks.

I got a sub questionnfor you guys. I been taking about 3mg of subs a day since monday this week and am really just trying to wait it out until I get paid this friday the best I can, constantly thinking about getting high of course..Last week I blew my whole check within the weekend so this time I'm gonna use once then save the rest for thruout the week and not just binge nonstop on it.

But my question is, what day should i stop taking my subs to feel the dope real good on friday? Could I take it thursday morning around 11 and have it out of my system by 1p.m the next day? I've only been using subs to help the w/ds and have only been on them for 3 days so far, so would this have any signifcant effect? Thanks.

edit- I should add that i dont have a script for these subs. I only have 4 1/2 left anyway. I also always IV my heroin if that matters.

I would give it at least 12, 24, or 36 hours depending on how you feel.

If you are blowing your paycheck then isn't it a better idea to forget about using heroin for a while and to use Suboxone as needed? 3mg is a good amount to be on, and it's easy to taper down from there. Then, maybe with a break you won't use heroin as often or as constantly? Few find it possible to return to 'chipping' after getting clean but it can be done.

 

[Georgie25]

Yeah, I'm constantly debating whether or not to stay clean for good, but my cravings are still so intense even though i dont have the physical w/ds on subs at least. I guess i gotta find a way to help ease these cravings cause I'm just thinking about using all day unfortunately.

 

[negrogesic]

I found suboxone to have very shitty analgesic properties. Well, i suppose snorting something that contains naloxone isn't great for pain....

 

[Dankycodone]

I can never compare painkilling of bupe to other opiates since I only use them recreationally make's me wonder lol. I am done shooting it tho I guess, since when I filter I lose so much and I only bang little amount's. Plus I know its horrible to shoot pills. I guess I have to snort or sub but I don't even know if its worth it at 1-2mg's.

 

[BiggDirty01]

To CH:


This guy is actually a new doc, a close friend to my best friends father who has his own history of abuse/recovery (he forgot we had met twice during July 4th's years past). The guy is twenty times better than the greedy cocksucker who was treating me and getting my sister addicted! (another story)

The new doc gave me his cell phone and I have been calling him throughout these first 24 hours and he is so willing to talk, almost about anything. He said doing a quick sub taper would allow him to try some alternative therapy on NO narcotics at the end of the taper, review records and tests and decide on a NEW PM course that, according to him, may not even include pain meds.

He is a DO with this sub specialty in PM/Addiction and I feel like the alternative approaches of DO's vs MD's is yet another reason im optimistic.

CH, do you think this a workable plan for a guy who has disc disease/bulg/neuropathy and sciatica bilaterally.

also: Is a 2 week taper going to leave me feeling any W/D because right now at 7mg/a day for 3 days I feel fine, almost great. I am supposed to taper 1 pill every 3 days?

 

[Captain.Heroin]

CH, do you think this a workable plan for a guy who has disc disease/bulg/neuropathy and sciatica bilaterally.

also: Is a 2 week taper going to leave me feeling any W/D because right now at 7mg/a day for 3 days I feel fine, almost great. I am supposed to taper 1 pill every 3 days?

I don't know if it's workable. I know that it's hard to give up opiates, even harder when you have legitimate pain (which transcends beyond the aches & pains of WD). I do know people with moderate back pain, and buprenorphine treats their pain well at a low dose (after tapering down).

So, I can't really say. Some people don't get much analgesic properties out of buprenorphine, others get a lot more out of it.

You will still probably feel WD after a two week taper, but it'd be a lot better than straight up cold turkeying.

It sounds like your doctor is willing to help you out any way you want to go. Best of luck man, and I hope it goes well for you.

If you have any other questions feel free to ask away.

I found suboxone to have very shitty analgesic properties. Well, i suppose snorting something that contains naloxone isn't great for pain....

It has nothing to do with naloxone though. Subutex has the same analgesic properties of Suboxone.

Some people get a lot more analgesia out of buprenorphine than others. I think it's very efficient, but you need a low opiate tolerance for it to be the most efficient.

 

[fistful_of_needles]

Was wondering if anybody has any info to share regarding Subutex and Tramadol use and consequent effects on the liver ... to be more precise my case in particular is that I'm currentely using both substances in order to stay away from a heroin habit which lasted over 15 years of IV use ,even though I've been "clean" for over 6 months now I'm worried about Subutex/Tramadol effects on the liver cause through all that time of IV use I contracted Heps C and am just about to do a biposy in order to access the gravity of the situation with the very real possibily of having to undergo treatment ...my doc has told me that I need to keep clean(from H/coke at least) in order to start this treatment which will last for 48 weeks altogether and since I found his answers to be somewhat vague regarding Subutex/Tramadol I'd appreciate people's personal views on this ... thanks in advance.

 

[Captain.Heroin]

Was wondering if anybody has any info to share regarding Subutex and Tramadol use and consequent effects on the liver ... to be more precise my case in particular is that I'm currentely using both substances in order to stay away from a heroin habit which lasted over 15 years of IV use ,even though I've been "clean" for over 6 months now I'm worried about Subutex/Tramadol effects on the liver cause through all that time of IV use I contracted Heps C and am just about to do a biposy in order to access the gravity of the situation with the very real possibily of having to undergo treatment ...my doc has told me that I need to keep clean(from H/coke at least) in order to start this treatment which will last for 48 weeks altogether and since I found his answers to be somewhat vague regarding Subutex/Tramadol I'd appreciate people's personal views on this ... thanks in advance.

Sorry to hear about hep C.

You can take Subutex and Tramadol together it should be fine. As for your liver, if it had any potential of harming your liver I doubt your doctor would prescribe it.

Yeah, I'm constantly debating whether or not to stay clean for good, but my cravings are still so intense even though i dont have the physical w/ds on subs at least. I guess i gotta find a way to help ease these cravings cause I'm just thinking about using all day unfortunately.

I'd say get clean for good, life will be a lot easier when you're not addicted/dependent.

 

[Eight0Eight]

Back to sub I go.

Been bag on the gear for 6 weeks/2months or so.

Got up this morning, and the cash machine told me to fuck off.

Luckily, I have a BIIIIG stash of subutex. Thank fuck for blind pharmacists.

Kind of releived - it was only a matter of time before my luck run out.

Time to get clean. Again.

Gonna stabilise over the next few days, on whatever dose I need - then QUICKLY knock it down to less than 1mg. I have an appointment on the 23rd, hopefully I will be able to just get a detox script of Lofexidine/benzos/quinine/stomach cramp meds.

 

[Captain.Heroin]

Back to sub I go.

Been bag on the gear for 6 weeks/2months or so.

Got up this morning, and the cash machine told me to fuck off.

Luckily, I have a BIIIIG stash of subutex. Thank fuck for blind pharmacists.

Kind of releived - it was only a matter of time before my luck run out.

Time to get clean. Again.

Gonna stabilise over the next few days, on whatever dose I need - then QUICKLY knock it down to less than 1mg. I have an appointment on the 23rd, hopefully I will be able to just get a detox script of Lofexidine/benzos/quinine/stomach cramp meds.

Sorry to hear about the relapse man, but I'm glad you're getting back on Subutex. Stick on buprenorphine for a whlie, see if you can get away from H for even longer; that should definitely help.

I recently tapered my dose down an extra 20% to 0.2mg per dose, so I know you can do it man. Best of luck.

 

[boxcut3]

Tapering w/ heroin?

I'm a heroin addict and I have been IV'ing about a gram everyday for awhile now. I have Suboxone but only a month's worth. The last few times I tried to switch over to Subs my opiate tolerance was too high and the Subs didn't even touch the withdrawals. In fact, I was prescribed Clonidine, Odensetron and Subs and it was still one of the most agonizing experiences I've ever been through, long story short, I didn't succeed.

Anyways, so I really want to get clean again so I decided to start tapering my heroin dose down. It's been really hard but I've actually managed to get from using about a gram a day to about 2-3 packs a day (which is a huge drop). I'm getting ready to switch back over and try the subs again with this lower tolerance but I'm wondering if anyone else has had this problem with Subs not working at all and if so, what did you have to do to get them to work? Should I just keep trying to taper with the heroin?

Honestly I'm surprised I've been able to taper at all considering how bad the addiction has been. I guess I'm just finally sick & tired of being sick and tired. Anyone have any similar experiences and/or suggestions. Sorry if this isn't posted in the right thread, I wasn't sure where this was best suited.

 

[dogfood]

i tapered down from heroin but i didn't go on subs i just kicked cold turkey. i tried methadone but it introduced more problems than it solved... never had the chance to use suboxone though.

 

[dunn2500]

suboxone for 3 days any WD?

coming off 4-5 norco a day for 1 year after accident/surgery.....a buddy gave some suboxone and i took 2mg, was way too much....so am thinkin .5mg and only gonna do it for 3 days.....will there be any w/d coming off this stuff?.....i know there are nightmare stories of WD off this stuff but for the limited dose and short duration of time for me maybe not?.............thanks

 

[Jabberwocky]

merging.

yes, expect some wd's. you're switching from one opiate to another so you're still going to go through them. the more your taper down your dose the easier they will be. have you looked into OTC remedies or other aides to help you through if they get too uncomfortable? i suggest you do