Bupe Suboxone/Buprenorphine FAQ & Megathread v3; 2010 - 2022

[catcalls]

Just because you can beat the withdrawal in a week or two doesn't mean you are mentally ready to quit, this is the reason most people use for long periods of time.

Did I say I beat the withdrawal in a week or two?

I've been on Subutex 4 years in 2011. I know all about the mental addiction of heroin.

 

[Wesley_pipes_27]

Help, missed a shot.

Hey guys, I have a quick question? I was IV'ing a 4mg shot of Bupe to the vein on the top of my left hand when the needle slipped and a small amount (maybe 1/10 of a 1/2cc syringe) went into my hand outside to vein. I immediately removed the needle and wiped the injection site off with an alcohol swab.

At first there was a small lump at the injection site, but over the last 30 minutes it has almost completely disappeared. There is no discoloration and only the slightest pain when pressure is applied. Kinda like a bruise w/o the blue & black.

I am fairly experienced with proper IV'ing technique and by being very careful I haven't ever missed a shot until this incident. I have seen the damage a missed shot leading to an abscess can cause. My main question is what signs & symptoms should I look out for to alert me that it's time to go to the emergency room. I do not have medical insurance and can't to go to the hospital unless absolutely necessary.

As of right now (1+hours after) I still have no discoloration and very minimum swelling at the injection site. I am hoping that since it was such a small amount, my body will just absorb it. Also, I was using 1/2 of an 8mg Midlothian Labs brand Subutex, which are very small, about the size of a 30mg Actavis oxycodone IR (hence less fillers & such).

I am very open to everyone's opinion and would love some feedback on this issue. I would especially like to hear from you Capt. Heroin, as you seem to be very knowledgeable. Mods, I believe I followed all BLUA rules, however if I made a mistake then please let me know.

Thank you,

WP

 

[Been&Done]

3.5 months of Subs after 10 years of H, and don't really feel like getting wd's. I never experienced with them for all this time. My maximum was 3 weeks, but then again, i went back to H straight away! I think i'm doing well this time, and 99.9% i'll never be back to any daily habits. It was too much to wake every single Freakin' day looking for your dose, money, calling the dealer, TOO much for TOO long!

 

[rolls_]

Did I say I beat the withdrawal in a week or two?

I've been on Subutex 4 years in 2011. I know all about the mental addiction of heroin.

Why did you say that the only reason to use sub for more than a week was so you were addicted to it then?

 

[Beerman]

Question to Captain H, what does ORT mean?

And btw.. anyone knows if there's something I can take to help bupe turn into NORbupe (full agonist) more effectively (sp?) than "not-taking-anything"? some CYP3A4 natural or synth inducer or something...

Thanks a lot.

 

[rolls_]

ORT = opiate replacement therapy eg suboxone or methadone.

 

[jnicolas1980]

I think it depends if the PAWS is from heroin/your full agonist opiate of choice, or id its from the buprenorphine itself.

If its from the full agonists, you can maintain on buprenorphine until you are past all of that.

My question was if I quickly get onto a low dose of suboxone in the first week (.5mg a day) and gradually lower it a week later, will I still be looking at significant withdrawals when I finally jump off (assuming I taper slowly; I'm planning on getting to .25 a day, then every other day, every third day, etc.).

Previously, I was on oxycodone, roughly 150 mg a day, though I had tapered by the end. Any help is appreciated.

 

[Beerman]

^ ^ thanks

 

[euphoriachaser]

I'm very pleased with 24+mg of loperamide to combat sub w/d. I decided to quit from a 2mg habit (4th time) because I don't have a "legitimate" source of subs and the sources I do have are rather unreliable (junkified). Also,after using subsfor awhile I start to feel "off". If I end up hooked on loperamide so be it. Atleast I'll have access to it 24/7 and be functional.

I'd recommend some benzos for the first few days of "adjustment". It takes me a bit to feel normal switching from full ag. opiates to subs and it seems like the same is holding true for subs to lope.

 

[euphoriachaser]

Hey guys, I have a quick question? I was IV'ing a 4mg shot of Bupe to the vein on the top of my left hand when the needle slipped and a small amount (maybe 1/10 of a 1/2cc syringe) went into my hand outside to vein. I immediately removed the needle and wiped the injection site off with an alcohol swab.

At first there was a small lump at the injection site, but over the last 30 minutes it has almost completely disappeared. There is no discoloration and only the slightest pain when pressure is applied. Kinda like a bruise w/o the blue & black.

I am fairly experienced with IV'ing and I have never missed a shot of anything, ever. I have seen the damage a missed shot leading to an abscess can cause. My main question is what signs & symptoms should I look out for to alert me that it's time to go to the emergency room. I do not have medical insurance and can't to go to the hospital unless absolutely necessary.

As of right now (1+hours after) I still have no discoloration and very minimum swelling at the injection site. I am hoping that since it was such a small amount, my body will just absorb it. Also, I was using 1/2 of an 8mg Midlothian Labs brand Subutex, which are very small, about the size of a 30mg Actavis oxycodone IR (hence less fillers & such).

I am very open to everyone's opinion and would love some feedback on this issue. I would especially like to hear from you Capt. Heroin, as you seem to be very knowledgeable. Mods, I believe I followed all BLUA rules, however if I made a mistake then please let me know.

Thank you,

WP

Just keep an eye on redness and if it feels hot. I've done exactly the same thing and it just goes away. It seems to happen when I'm making multiple attempts to hit a vein.

 

[synchronous]

suboxone question

I do not have a huge tolerance by any means compared to others, but I would like to know some more about suboxone..

I am looking for a painless wd..

Why are some people on suboxone for so long, can't you just be on it for a short time when you no longer have a dependence anymore to the opiates you were taking.

I was liking how it sounded then I read others that were taking it and coming off of that is terrible..


I was able to talk to a a doctors office today that does the suboxone, this is what they said.

250.00
750.00

1000.00 total for one month.

i don't know what the 250 is and the 750 is but pretty much you pay 1000 total to start the meds and such and it is out patient so you do not have to spend any time at the place or over night, I believe you do not have to spend any length of time their for the day..

they screen you afterwards to test for liver and such but i think that is just to make the package sound better..


ALL i care about is having no w/d and be done, i don't want to be on suboxone to where I will have to deal with w/d and 1000.00 is not cheap so i don't want to spend any more then this either!

The only good thing is they can see you right away, where as other places are telling me, 3 weeks from now, well i will be in w/d in a day!

so is it worth it or what.

60mg oxycodone a day for months, plus fentanyl. if i were to take 60mg of oxycodone, i wouldn't feel "high" so that is where my tollerence is at. really i don't want to ride it out cold turkey either. i have bad pain issues, still dealing with severe pain issues from a accident and i am stuck in this situation since i didn't see my doctor and the time i can see him again is a good couple weeks away.

tell me about sub related questions please.

 

[haden]

Nice post, Haden. I'm new to subs, so that was a good read. My only question now is regarding PAWS. I've been on suboxone for a little more than a week, having started off with 6 mg a day for the first couple of days, then down to 3 mg a day for another couple of days, then 2 mg, then 1 mg, and now I'm at about .5. If I stay at .5 mg over the next week and go down to .25 for another week before jumping off, do you think I'll still get PAWs? I know it's probably impossible to say for sure, but I guess my question is, is it possible to avoid it if you start low enough?

You are really in a good way in terms of not experiencing too much, if any, PAWS, in my opinion. From my research it seems like those who suffer the worst PAWS are those who have been using bupe for extended periods of time (i.e. months, years, etc...) Bupe is a very powerful drug so if you were to stay at a dose as low as even .5mg for too long, it could be very hard to jump off.

I would do exactly what you're doing and try not to stay on the bupe for too long. If you have will power and self control you can utilize bupe very effectively to experience minimal acute/post acute withdrawal symptoms.

This is all just my opinions though, I could be wrong. One factor that I would assume is important in the equation is what your drug use was like before the bupe taper. For instance, if you had been taking long-lasting opioids like methadone, you would begin to feel pretty bad post acute withdrawal symptoms after you finished your bupe taper.

PAWS is a bitch, because it makes relapse nearly inevitable. The mild chills, the subtle aches, the night sweats and insomnia, etc... And to take your d.o.c. will take it all the shitty feelings away... Try and get really psyched about sobriety and ride a bike, drink tea, fuck beautiful women, etc... This can make a world of difference. If you sit around focusing on how bad you feel it will make PAWS so much worse. Also, reward yourself with luxuries such as fine wine (if you are a drinker), hot baths, saunas, or delicious healthy meals as much as possible.

I am fairly new to bupe myself, so maybe someone with more experience and knowledge can help you, like Captain Heroin. Good luck!

 

[haden]

megathread?

There really isn't such a thing as painless WD but if you use it right it could make your inevitable WD alot easier and less painful.

One thing I can say for sure is use as LITTLE AS POSSIBLE. If this means feeling a little under the weather, that is ok: you will thank yourself when you are finally off them. The doctor will fuck you over if you follow his dosing instructions (assuming he is like every subdoc I have ever heard of). He will probably prescribe ridiculously high daily doses that will be very hard to come off of if you use for too long.

Look around the megathreads and you will find all the information you need. Seriously, it has been covered way too many times!

 

[funkee]

There is plenty, and I mean plenty of reason to stay on Sub for as long as possible.

There have been numerous studies that examine the efficacy of the duration of treatment.

I read one study in detail, while thumbing through a pharm textbook at my doc's office. This study examined the relapse rates of about 400 individuals. The rate was measured 3 years after stopping treatment. Candidates had to attend some kind of therapeutic treatment (group sessions, 1on1, etc) at least once a week, which started before discontinuing treatment and continued for at least 6 weeks after stopping treatment. They compared the relapse rates of these users who had varying durations of treatment in the past decade or so and came up with the following:

No buprenorphine treatment: 12% did not relapse after 3 years
1-2 weeks of treatment: 18% stilll clean
3-7 weeks: 25%
8-21 weeks: 34%
22-52 weeks: 48%
53 weeks - 3 years: 67%
3years 1 day - 5 years: 80%
5years 1 day - 10 years: 88%
10years: 90% (not statistically relevant)

I guess the last figure did not have enough members to be statistically relevant, probably because Suboxone is relatively new. I'm not sure if this study was conducted in the US. I think bupe treatment in the UK goes back a bit farther than it does here.

In my opinion, it demonstrates the obvious. However, these are assumptions I've made based on this data: the goal behind suboxone is not just to avoid physical withdrawal, but to let your brain and receptors heal. You could do an ultrarapid (overnight) nalaxone treatment and come out, but you wouldn't be any better off. Your brain is still horribly deprived of dopamine and is unable to produce it for itself. You need to get accustomed to living without opiates, and without the rash fluctuations of dopamine so that your brain can produce it in sustainable quantities. Rapid detox by bupe is only going to bypass the worst physical symptoms. You will still face the gruesome psychological symptoms and you wouldn't have time to mentally prepare for sobriety.

There was another part to this study, which examined the ending dose of users who relapsed and were on bupe for 1 year or less. If I recall, 2/3rds of those who relapsed, came off at a sub dose that was 1.5mg (total daily) or higher. I will try to pull that study and confirm these figures.

 

[funkee]

If you are looking at buprenorphine to cover the time until you can see your doctor again, I would think again. Bupe should not be used as a crutch in this way. If you need more meds, you can call your doc and they can call/fax it in. If you're looking to get off short acting opiates, continue reading.

There are different reasons for using higher doses and lower doses. There are a few, unlikely situations where you might need high doses (16 to 32mg+). My doctor charges $200 a session, possibly more for the first session. Find a reputable treatment center and look for reviews. There are a lot of sub doctors, so shop around.

Some doctors don't require a great deal of blood work. Some will throw in a bunch of unnecessary tests to pocket some money. Some places don't require anything but a piss test which can cost up to $50. Some don't even ask for one!

Suboxone will definitely make your w/ds easier. The longer you stay on the better your chance of leading a clean life. The lower your dose that you can jump in at, the easier it will be to eventually get off.

I must disagree with the above post, in regards to using as little as possible. You want to make sure that the dose you're at doesn't leave you symptomatic. After that of course there's no need to go higher. Symptoms (in addition to environment, stress, and availability) are in my opinion the greatest trigger of craving. In order to succeed in the long run, triggers of craving must be addressed.

If you are a pain patient, look for a doctor that is experienced treating pain patients rather than heroin addicts. Their approach will differ in some very key ways; primarily by addressing your pain needs. Buprenorphine is strong enough to cover most pain; however there are other options available to you if you are a life long pain patient including methadone and LAAM.

Best of luck, and check out the FAQ megathread.

 

[synchronous]

a] Thank you, tomorrow if everything works out right I should be able to get on it..

b] Will the doctor ask me what I am currently taking and I know I am taking less then a lot of people where they take 200+ oxycodone a day.

c] what i am saying is: will the doctor turn me down if my usage isn't very high, 50mcg fent, 50mg hydrocodone daily for a year, i have tried to stop and i can't stand it, i know some could but not for me to go that route.


d] I tried a place today that was much cheaper, it was more so for drug rehab +sub - and the person turned me down since i said I was a pain management patient, i even tried to change what i said and was like sorry i was being not straight forward and do buy it and get it other means but the person was like sorry but you sound like somebody that needs to try through the doctor and have your doctor fix this..

thank you for the replies, in reference to "c" that won't be a problem will it, being my usage.

 

[Tommyboy]

Well it seems like you want to use it just to detox, and not for maintenance. All you really need is like 6 mgs to ween you off.

If you are going to have withdrawals from what you are currently taking, then the doctor will take care of you. It is just a lot of money to spend when all you would need is 1 pill to detox.

Due to $, I would say taper down with what you already have, and then put up with 2 days of feeling shitty.

Edit: I know that without insurance most suboxone prescriptions are around $650, so maybe that is what the 750 price was. Most doctors do not realize how potent suboxone is, so often raise you tolerance rather than lower it. If they are willing to prescribe you a couple of the 2mg pills, then it should not be too expensive. The price is listed is for a month prescription, and I think is usually for more than 1 pill a day. You can taper starting with 3mgs and then drop it by 1mg until you are at 1mg. Then just cut the dose in half til its gone. So that would be a total of 7mgs.

 

[Wesley_pipes_27]

Just keep an eye on redness and if it feels hot. I've done exactly the same thing and it just goes away. It seems to happen when I'm making multiple attempts to hit a vein.

Thank you Euphoria, I will continue to watch it closely. As far as multiple attempts is concerned, that is exactly what happened to me. I had to do it twice because because the vein moved on me the first time.

It has been 12+ hours now since it happened and everything seems to be looking okay. There are no red lines, it's not hot, there is no discoloration, and I am not having any flu like (infection) symptoms. It is still somewhat tender at the injection site though. I will continue to watch it closely.

WP

 

[euphoriachaser]

There is plenty, and I mean plenty of reason to stay on Sub for as long as possible.

There have been numerous studies that examine the efficacy of the duration of treatment.

I read one study in detail, while thumbing through a pharm textbook at my doc's office. This study examined the relapse rates of about 400 individuals. The rate was measured 3 years after stopping treatment. Candidates had to attend some kind of therapeutic treatment (group sessions, 1on1, etc) at least once a week, which started before discontinuing treatment and continued for at least 6 weeks after stopping treatment. They compared the relapse rates of these users who had varying durations of treatment in the past decade or so and came up with the following:

No buprenorphine treatment: 12% did not relapse after 3 years
1-2 weeks of treatment: 18% stilll clean
3-7 weeks: 25%
8-21 weeks: 34%
22-52 weeks: 48%
53 weeks - 3 years: 67%
3years 1 day - 5 years: 80%
5years 1 day - 10 years: 88%
10years: 90% (not statistically relevant)

I guess the last figure did not have enough members to be statistically relevant, probably because Suboxone is relatively new. I'm not sure if this study was conducted in the US. I think bupe treatment in the UK goes back a bit farther than it does here.

In my opinion, it demonstrates the obvious. However, these are assumptions I've made based on this data: the goal behind suboxone is not just to avoid physical withdrawal, but to let your brain and receptors heal. You could do an ultrarapid (overnight) nalaxone treatment and come out, but you wouldn't be any better off. Your brain is still horribly deprived of dopamine and is unable to produce it for itself. You need to get accustomed to living without opiates, and without the rash fluctuations of dopamine so that your brain can produce it in sustainable quantities. Rapid detox by bupe is only going to bypass the worst physical symptoms. You will still face the gruesome psychological symptoms and you wouldn't have time to mentally prepare for sobriety.

There was another part to this study, which examined the ending dose of users who relapsed and were on bupe for 1 year or less. If I recall, 2/3rds of those who relapsed, came off at a sub dose that was 1.5mg (total daily) or higher. I will try to pull that study and confirm these figures.

I find it curious that bupe would "heal" anything in the brain. From what I've experienced (and ALOT of others) bupe screws with it more than traditional opiates. I believe this is evident in the length of physical withdrawal and more importantly the long and strange duration of PAWS.*

I'm not doubting your motives at all. It definitely is a must for some people that are at a certain point, but most if not all the medical community is misinformed about bupe/subs effects and it is WAY over prescribed . I suspect most of it comes from the "Lysol (tm) company's" advertising and training programs.

*Edit

I misread what I thought was in the report rather than what you personally thought was happening regarding bupe and brain healing.

 

[funkee]

a) That should be fine. Keep in mind you will need to wait until you are in withdrawals prior to taking sub, or it will cause rapid withdrawals that are very unpleasant.
b/c)They will ask you what you are taking, but they won't turn you down because it is low
d) Keep trying different places. Some doctors and facilities are out there to take your money. Some places may feel that their approach isn't suitable for pain patients, because their needs differ from addicts.

Most people would suggest talking to your doctor, but by doing so you may lose the ability to get opiates from them in the future. You should decide if you want to quit for good. Keep trying places, there are many. Find one that's suited to treated pain patients.

You can ignore the person who says you need 6mg (less than 1 pill) to detox. We aren't physicians and we don't know anything about your history. We are not here to prescribe your medication or tell you how often or how much to take. We are not licensed to prescribe buprenorphine. There is a special license a doctor must obtain in order to prescribe it. That's why some doctors can't prescribe it at all. Your doctor will find a dosage and schedule that is suitable to your habit, your body, your mental state and your goals. Please refer to the study I posted at the end of the sub faq megathread in regards to relapse rates.