Opioids Suboxone

[Squid007]

Just a quick one, mate is on 4mgs of suboxone daily and wants too wean off and be finished in a month. Is it easier too change to methadone because it's liquid and to cut doses is simple because he has tried breaking the suboxone and it crumbles so difficult to cut dosage. The film is no option in South Africa.

 

[darvocet21]

He wants to use methadone to taper subs can work... A finesse move take the methadone for only 2 weeks and then have about 30 Tramadol on standby. 50mg PRN 4-6 hrs

 

[Las Veghost grower]

Tell him to dissolve his strips in water and dose with a baby medicine plunger thing…so if you put a 4mg strip in 16ml of water every 4ml will equal 1mg…so he can cut down to .25mg easily that way

 

[darvocet21]

Tell him to dissolve his strips in water and dose with a baby medicine plunger thing…so if you put a 4mg strip in 16ml of water every 4ml will equal 1mg…so he can cut down to .25mg easily that way

That doesn't make sense Veghost. Sure it will dissolve but you'll have to remember to shake it vigorously each time and there may be gelling agents that never fully dissolve. No I would just say get a good small sharp pair of scissors a nice bright lamp get in there and cut in half, turn and cut in half again. With brand name Suboxone which may not even be sold anymore the 8/2 was a pretty good-sized rectangle, 3/4" x 1/2" roughly

Easy to get down to 1 mg boxes like hits of classic blotter paper

 

[Las Veghost grower]

That doesn't make sense Veghost. Sure it will dissolve but you'll have to remember to shake it vigorously each time and there may be gelling agents that never fully dissolve. No I would just say get a good small sharp pair of scissors a nice bright lamp get in there and cut in half, turn and cut in half again. With brand name Suboxone which may not even be sold anymore the 8/2 was a pretty good-sized rectangle, 3/4" x 1/2" roughly

Easy to get down to 1 mg boxes like hits of classic blotter paper

Iv done it plenty of times with no problem, just drop the liquid under your tongue and your good, I would just store it in a cabinet in the kitchen…but whatever works for you I guess

 

[darvocet21]

Iv done it plenty of times with no problem, just drop the liquid under your tongue and your good, I would just store it in a cabinet in the kitchen

I'm sure it works and I remember now that OP called it "suboxone" so I think we can both be forgiven for referring to what he has as strips even though he said that it doesn't come in strips in South Africa, only tablets that crumble. For some reason I always think of strips and I think that's because they didn't ever have tablets until later.. Your advice is good advice.

 

[0.o_LaCuNa_o.0]

Yeah I think the OP is talking about the tabs, not the strips.

 

[Las Veghost grower]

Oh I forgot they even make suboxone tabs anymore, but I bet they will dissolve too..maybe dissolve in some vodka or something if it clumps up in water, if that don’t work I’m out of ideas

 

[Imaginarium]

Just a quick one, mate is on 4mgs of suboxone daily and wants too wean off and be finished in a month. Is it easier too change to methadone because it's liquid and to cut doses is simple because he has tried breaking the suboxone and it crumbles so difficult to cut dosage. The film is no option in South Africa.

Hi,

Ideally, the tapering process should be discussed with your friend's physician who prescribed them the medication. I'll provide some input and information around the two substances and the South African context, but please note as a disclaimer, that my input should not be taken as medical advice.

Suboxone (buprenorphine-naloxone) as a sublingual tablet is the only product currently registered on the essential medicines list (EML) and is available as 2mg (2mg/0.5mg) and 8mg (8mg/2mg) strengths. The tablet is not scored so it's difficult to split and crushing is not recommended as it would impact the bioavailability. Given the 36–48-hour half-life, a person would need to wait until they were in mild to severe opioid withdrawal before slowly up-titrating with oral methadone to avoid precipitated withdrawal. In my experience, precipitated withdrawal can be a rapid, debilitating and traumatic event.

The current Southern African HIV Clinicians Society guidelines provide some guidance around this. Being on a dose of <8 mg daily, the guidelines suggest that the down-titration process should be done by reducing the dose by 2mg per week or fortnight, however, slower tapering may be needed; which is what your friend wants to do? Rapid detoxification (< 30 days) is not recommended, but mild withdrawal can be managed symptomatically, with antidiarrhoeal, antinausea, anxiolytic and analgesic medication. How painful and unmanageable the withdrawal depends on various factors and is subjective. Personally, my withdrawal experiences (multiple times with methadone and buprenorphine ± naloxone) have varied so much, and have been impacted by soo many factors.

In my opinion, switching between methadone and buprenorphine-naloxone can be time-consuming and complicated, which might impact your friend's goal of < 30 days? I've been through this experience multiple times, with a lot of trial and error. It's a difficult process and I know how tough it can be.

I do wish them all the best though!