Suboxone questions.

[bigbadrobin]

Gday.

A mate of mine was addicted to oxycontin for about a period of 2 years. 5 months ago he went to his doctor and was put on the suboxone program. He currently takes 32 mg of suboxone per day, 4 x 8mg strips. He has been on suboxone for 5 months and clean off all other drugs. He has been diagnosed with depression and bipolar aswell and takes anti depressants and other medications prescribed by the doctor. He just has a few questions he wishes to ask and get some opinions.

1. Once you let the suboxone films dissolve and then you spit out the excess liquid, what is somthing good to eat/drink to get rid of the terrible taste? The only thing he has found so far is ice cream and orange juice. But that costs to much and is not good for his weight. What methods do you guys use to get rid of the after taste?

2. He plans on coming off this program in the next 6 months, and is assuming that his doctor will slowly withdraw him right down to 1mg and maybe even lower. Is this how the withdrawl process goes? if you taper off slowly do you get any opiate withdrawls compared to oxycontin withdrawls or cold turkey or somthing?

Thankyou for all the help.

 

[Crankinit]

1. Once you let the suboxone films dissolve and then you spit out the excess liquid, what is somthing good to eat/drink to get rid of the terrible taste? The only thing he has found so far is ice cream and orange juice. But that costs to much and is not good for his weight. What methods do you guys use to get rid of the after taste?

Two things. Firstly, you have to wait longer than it takes for the film to dissolve. It takes 3 or 4 minutes for the film to dissolve into the saliva, creating a film/saliva solution, at which point the buprenorphine itself starts being absorbed sublingually. If he's only waiting for the film to dissolve (and especially if he's spitting it out) then he's probably only getting a fraction of the effect. Although he's on a pretty big dose , so that might still be effective, especially as bupe as dimnished returns after 8mg.

I'm curious - how much oxy was he taking? 32mg is a pretty big dose. Sub doctors seem to sometimes sometimes push the massive doses for some reason even in situations where it's not necessary (putting people with codeine habits on 16mg and other absurdities) - I assume the training they're given tells them to do so, maybe in an attempt to increase half life and therefore compliance and/or comfort, or to make sure the patient is covered as much as possible, but I don't know.

I'm curious now, going to ask my doctor what the training to prescribe subs was like next time I see her.

As to your question, I usually either pop a fruit flavored mentos or two in my mouth, then wash it down with water a minute or two later, or just wash it down with milk and keep sipping on the milk for a minute or two after. The mentos get rid of the shitty sub flavor within a few minutes, but if the sugar content of them is too high for him, maybe he can find some kind of low sugar/fat drink that should do the trick - skim milk maybe?

Could talk to a nutritionist about something healthy and tasty to drink. Home made fruit juice? Surely there's something he can drink other than water - the trick is to keep sipping on the drink and keep it in your mouth, swishing it around to get rid of that sub taste. Eating a small bite of something helps too.

I can sympathize though. I've fallen asleep with subs in my mouth more than once and woken up 2 or 3 hours later - took another 2 or 3 hours to get rid of the flavor. Ugh.

2. He plans on coming off this program in the next 6 months, and is assuming that his doctor will slowly withdraw him right down to 1mg and maybe even lower. Is this how the withdrawl process goes? if you taper off slowly do you get any opiate withdrawls compared to oxycontin withdrawls or cold turkey or somthing?

I can't speak from experience regarding the final taper because I'm still on my subs, but my understanding is that the taper minimizes the acute withdrawal symptoms by spreading them out over a period of time (although they won't be felt constantly). He might feel a little off, a bit uncomfortable, for a day or two every time he lowers his dose until his body adjusts, depending on how much he lowers it by each time. And usually people go down to 0.5mg or occasionally 0.25mg before they stop entirely - some report that it's relatively painless to jump off at this stage, others say it's uncomfortable (although nothing compared to a cold turkey of either oxy or suboxone).

That said, 32mg is, as I said, a big dose (the maximum), if he insists on coming down from that to zero in 6 months, there's gonna be discomfort. I'm on 24mg and I plan to taper over a year, and even that I don't expect to be a ton of fun.

Best of luck to your friend.

 

[mostly-human]

32mg of sub is waaay too much. Doesn't matter what you were on previously, you should aim to rapidly decrease the sub dose down to about 4-6mg as rapidly as possible.. That is still plenty enough to kill off the ability to get high from opiates and most people can find a sweet spot around 4-8mg where you don't psychologically 'hang out' to get high.. (2mg doses can often leave you craving, I've found).

But yeah, 32mg is a stupid dose to stay on, you should change your doctor, if they're recommending that.. Stay on that dose too long and you're going to have a whole new nightmare.

Regarding the taste, well - when you drop down off that ridiculous dose, it won't be so bad. That said - I found take a sip of undiluted cordial helped a bit. But generally speaking, there's not a whole lot you can do; it just tastes bloody awful and that's how it is.

 

[mostly-human]

Also, in Australia, the lowest film you can get is 2mg, unfortunately with the old pills you could go lower, but for some reason they don't give you less than two.. Speaking from experience, this is a pretty uncomfortable dose to come off.. If you can, try and stash away a good 20mg or so worth of film, let yourself tape off in fractions of a mg, much easier.

 

[footscrazy]

I agree that sub does prescribed are way too high, to the point it's just causing harm. I've been surprised in the past by how little bupe you really need to hold you. I think most people would be fine on 8mg. Much over that I feel like it's just ramping your tolerance up ridiculously high and making it harder to get off, for very little extra benefit. I do think there's something in what you said, Crankinit, about increasing compliance. Taking 32mg daily means even if you stopped cold turkey you wouldn't get much of a high on anything else for days and days.

I agree with mostly-human about trying to stabilise on a much lower dose. Bigbadrobin, I reckon your mate should try and drop to under 10mg pretty quickly - and I've found the withdrawals from dropping from say, 16mg to 10mg are mild and nothing like as bad as a drop from 4mg to 2mg or 2mg to 1mg. He could also try dosing every second day as big doses hold you for awhile.

I hate the taste of bupe, though the strips are so much easier to bear than waiting for the tablets to dissolve was. They used to take so long to properly dissolve for me, and it's why I started sniffing my pills. I find it a much more effective way of reducing wd's with a very low amount too. I don't have any tricks for getting rid of the taste.

I came off bupe at the start of the year and I recommend dropping down as low as you can - I'm amazed by how many doctors propose jumping off when you're down to 2mg. I would get down to .5, .25 or lower if possible. I wasn't just sticking to bupe when I finally tapered so it's hard for me to judge how much of my withdrawal was due to bupe and how much was due to all the other shit, but coming off was fucking hard for me, and so drawn out. I did a codeine taper and if I had to do it again, I'd prob make the taper much quicker and more brutal to get it out of the way fast, rather than drawing the shit out with a longer taper.

 

[Crankinit]

Also, in Australia, the lowest film you can get is 2mg, unfortunately with the old pills you could go lower, but for some reason they don't give you less than two.. Speaking from experience, this is a pretty uncomfortable dose to come off.. If you can, try and stash away a good 20mg or so worth of film, let yourself tape off in fractions of a mg, much easier.

I don't know about what the general rule is, but my pharmacist had no problem dividing strips up with scissors when I was lowering my dose a bit. You could easily cut a 2mg strip down to 0.25mg, but some chemists might not be willing to - I hear a lot of horror stories from people with pharmacies less laid back than mine.

But yeah, as soon as you start getting take aways building up a bit of a stash is an excellent idea. You want to have some on hand incase you end up out in the rain for some reason or another.Some days you just can't plan your schedule around getting to the chemist, or things come up, or they screw you around with public holidays and so forth.

Much over that I feel like it's just ramping your tolerance up ridiculously high and making it harder to get off, for very little extra benefit.

I dunno, I started on the usual 4 then 8, and found ramping up to 16 and then again to 24 definitely gave increased effects, although not in a linear sense. 24mg probably feels 20 - 30% stronger than 8mg does, and also lasts a lot longer obviously. But my upper back was messed up at the time, so I was trying to maximize pain relief instead of just kill the psychological cravings (which I found bupe was a bit hit and miss for - mostly it just stopped the spur of the moment opportunities to get high).

Not arguing with what you're saying about trying to get down as low as you can comfortably, but doses above 8 aren't without benefits - just depends on the individual. And even on 24 I never had trouble indulging in frequent non-compliance for the first year and change - just took a bit of planning to do a quick taper for a few days off. But presumably we're talking about helping this guy get comfortable then get off the program, not stay on it long term and get high when he feels like it.

Although I also think 6 months is a bit short in terms of breaking the opiate addict mindset and making the lifestyle changes required to not fall back into old habits as soon as the subs stop getting in the way - but maybe that's just me and my messed up life, I dunno. Not sure how many people do those quick(ish) tapers and actually stay away from opiates afterwards. It took me 18 months to get to the point where I wasn't taking holidays every other weekend just because I had the cash to do so, then using the bupe as a stopgap the rest of the time. But I guess everyone is different.

I came off bupe at the start of the year and I recommend dropping down as low as you can - I'm amazed by how many doctors propose jumping off when you're down to 2mg. I would get down to .5, .25 or lower if possible. I wasn't just sticking to bupe when I finally tapered so it's hard for me to judge how much of my withdrawal was due to bupe and how much was due to all the other shit, but coming off was fucking hard for me, and so drawn out. I did a codeine taper and if I had to do it again, I'd prob make the taper much quicker and more brutal to get it out of the way fast, rather than drawing the shit out with a longer taper.

Did you find the codeine taper made things harder then? I have mine all planned out for the eventuality (see the tapering and withdrawal thread ), but I'm weighing up the benefits of jumping off a way lower dose (of a shorter lasting opiate, which seems like it would make things easier) versus the risk of triggering old habits by going out and buying a bunch of codeine - which is right where I started 5 years ago.

 

[footscrazy]

I dunno, I started on the usual 4 then 8, and found ramping up to 16 and then again to 24 definitely gave increased effects, although not in a linear sense. 24mg probably feels 20 - 30% stronger than 8mg does, and also lasts a lot longer obviously.

Yeah fair enough, you'd have a lot more experience than me with bigger doses. I just found it so hard to get off I hate the thought of adding extra weeks of that shit trying to come off a big dose.

Did you find the codeine taper made things harder then? I have mine all planned out for the eventuality (see the tapering and withdrawal thread ), but I'm weighing up the benefits of jumping off a way lower dose (of a shorter lasting opiate, which seems like it would make things easier) versus the risk of triggering old habits by going out and buying a bunch of codeine - which is right where I started 5 years ago.

Yeah, I did find the codeine made things harder. It didn't work like I thought it would. I was hoping that with a long codeine taper (around 2 weeks), that I'd 'switch' the addiction over to the shorter acting opiate which would be easier to come off. But being on codeine just seemed to extend the bupe wd more than anything, coming off the codeine in the end wasn't like coming off codeine, it was still like coming off bupe. Even when I got down to really small doses, less than 100mg a day, when I stopped completely it was like the full force of everything still hit me when I finally had no opioids in my system at all. I just feel like while I was taking something I wasn't really getting much better, and it took stopping everything to finally start to recover. And given the codeine never made me feel 100% better while I was tapering with it, that two weeks of tapering seemed like a waste of time.

But I don't know what it would've been like without it, maybe it would've been a shit load worse, I don't know.

 

[Crankinit]

Yeah fair enough, it can be hard to say with these things. All I know for sure is that I'm not looking forward to it

 

[Christ!]

Interesting discussion and good info.

Agree that 32mg is tons. It annoys me a bit because most people getting on Bupe don't understand just how much it is, and the addict part of them instantly thinks higher dose = more good. When I first got prescribed Bupe a long time ago it was strongly emphasized just how easy it is to taper off, no matter the dosage...I think Doctors are more realistic these days, but there still seems to be some issues around getting the best outcome for the patient and making sure things are explained properly.

AFAIK the thinking behind high dose opiate maintenance is to raise tolerance to a level where getting high on DOC is impractical/too expensive, and with bupe - impossible. You get the patient in a routine and they gain stability. You just about take away their risk of OD, disease/injury from unsafe practices, dangerous situations, crime etc. etc.

Where things need improvement is longer term outlook and customizing treatment plan for the individual. It's difficult to figure out what's best when we're talking about monitoring outcomes over many years though...addict is off the street, they're comfortable and that's where the interest ends with a tick next to their name.

Problem is we're all so different and that path isn't best for all - for me personally it would have been far better to get on minimum effective dose and taper off in a relatively short amount of time. I had a serious habit but my usage had only been short (less than one year) for a Doctor to put me on a huge dose of Bupe where my tolerance is pushed to the limit and opiate receptors get drenched 24/7 365 days for MANY years was not the best thing for me. I don't blame the doctor at all, she didn't understand how powerful bupe was and genuinely wanted to help.

Bupe can be a great tool, and it's literally life saving for many people. What needs work is more study and understanding around tailoring the treatment to suit the person. The one size fits all methods that GP's are trained on can do serious harm - it's just hard to recognize because for the most part opiate maintenance is incredibly effective.

Hope I haven't repeated myself and it makes sense as a whole. Got a bit of the ol' goldfish memory thing going on

Bigbad robin - Sorry for not focusing on your questions! Just feel strongly about the above and wanted to put my thoughts down.

 

[bigbadrobin]

gday all. my friend is very grateful for all the replies and was unable to get back to a computer to discuss this further.

After seeing all the posts, he is extremley scared about coming off this dosage. He has no idea why he was put on this dose, they started him at 24 and then upgraded to 32 within a 2 week period. He cant stand being on it and wants to come off of it.
Could someone please write him some sort of timeline to come from 32mg to nothing.

For example
drop from 32 to 24 and stay on 24mg for 2 weeks
drom from 24 to 16 and stay on that for 2 weeks
and so on and so on.

He wants least withdrawls possible, but wants to come off this fairly quickly. He can deal with withdrawls but he came off oxycontin cold turkey once, and went through 10 days of no sleep and complete hell. he does not want this to happen again. If anyone could please be so kind and help him with this taper plan, i know he would really appreciate it.

He is going to ring the doctor tomorow and tell them he wants to stop, but is afraid they will take him off it far to quickly and with his luck, will end up with massive withdrawls beyond beleif or even death. He plans to take the taper plans you guys provide, with him to the doctor and if the doctor disagrees, he will say he wishes to stay on it and come off it of his own accord.

He has also been clean for 6 months now and has absolutley no wish to touch any drug ever again, the thought of the things he used to do makes him sick in the stomach.
Any taper plans you guys could reccomend would be greatly appreciated.

Thankyou all.

 

[chugs]

My understanding is that once your down to very low doses of bupe that you can move to dosing once every 48 hours. If your mate is worried then he can always talk to his doctor about enrolling as inpatient facility whilst he withdraws so they can medicate him through the withdrawals from the bupe.

Clonidine and other drugs can help with the acute symptoms. Fun fact these symptoms are the result of Glial activation participating in the mediation of pain including neuropathic pain, due to release of neuroexcitatory, proinflammatory products.

Basically opiate withdrawals have nothing to do with "addiction" but everything to do with having shitting brain chemistry that gives you basically the feeling of having a cold/flu when your not on the smack.

This is why I've found that consistent/numerous small doses of vitamin C (and/or granny smith apples) strangely take the edge of of withdrawals.

Foots, why didn't you ask your doctor for any sort of medication to get through the withdrawals?