Tapering buprenorphine - should I switch from nasal to sublingual

[oldendaysbluelighter]

Hello all,

Been a long time since I showed my face here. Looks like things have changed a lot! I have always been a recreational (incl. opiates) drug user but never had addition issues until a couple of years ago I broke my shoulder and got on tramadol.
Won't bore you with the details but a whole load of stupid decisions left me snorting what I later worked out were the dreaded fake m30 oxys (i.e. fentanyl).No idea what the strength was but was snorting about 20 or 30 a day.

Managed what was an incredibly painful switch to subutex about 4 months ago but finding right dose was really hard and I'm still a massive addict so I ended up snorting them instead of sublingual. Managed to get myself 'stable' on 5mg snorted in the morning and 5mg in the evening. Since then I've battled hard and got down to the point where I'm now snorting 2.2 Mg in the morning and evening. I've been dropping my dose by around 10% each Monday and I find that I feel pretty shitty until about Thursday or Fridayt when I gradually begin to feel better. However, I am still regularly finding myself starting to feel WD - especially around mid-afternoon and when I first wake up - i.e. 8 to 12 hours after I last snorted.

I know WD is never going to be painless but I'm wondering if switching from insufflation to sublingual is going to help with the constant shit feeling? I had mentally devised a plan to get down to 2Mg twice a day in another couple of weeks and then each week move 0.5 Mg of my evening snorted dose to be 0.5Mg of sublingual in the morning instead. So after 4 weeks I'm taking 2Mg nasal / 2Mg sublingual in the morning - and nothing in the evening. Then switch the other 2Mg of nasal to be sublingual by the same process.

Only trouble in doing that is that over the next 8 weeks I don't go anywhere with the taper. If I carried on cutting the nasal dose for those 8 weeks I could be down to 1.6Mg per dose by then.

Can any of the kindly kowledgeable folks on this forum offer any insight on whether, by switching to sublingual, I might be able to keep the level of drugs in my blood at a more consistent level throughout the day?

 

[axe battler]

IME snorting increases the bioavailability significantly over sublingual use. Off the top of my head I think it's 50-60% BA for nasal and 30% orally, so you may need to increase the amount you're taking at first.

Snorting does also seem to shorten the effects too, so sublingual use should hold you for longer. It's worth a try.

Maybe you could try taking a larger dose sublingually in the morning, say 3mg, and seeing if that holds you until the next morning and go from there?

I don't see any reason you can't keep taking it twice a day though, maybe you could try taking 2.2mg sublingually for a day or two and see how it affects you.

The only reason I would suggest you stop snorting is the potential damage you're doing to your lungs. There's talc and other fine particles in the tablets that can build up in your lungs and cause damage (talcosis?) You could also avoid this by dissolving your dose in water and "waterline" it, but some people struggle with this.