Opioids Tramadol & suboxone/naltrexone...Precipitated Withdrawal?

[Shant]

It's so hard to get a firm answer on this. I have 2 doctors telling me literally the opposite info. I'm currently on heroin, gonna get on vivitrol in a few weeks. I'd like to switch from the heroin to the Tramadol, and then induct the suboxone. Stay on that for a week or so then quit everything for 10 days and get on vivitrol. So, the question is, if Tramadol is already in my system when I induct suboxone, will it cause PWD? One doc says yes because it's an opiate, and the naloxone/naltrexone will kick that out of the receptor and cause the PWD. That said, tramadol is not an agonist or partial agonist, so the naloxone/naltrexone shouldn't affect it, right? Has anybody here actually tried it?

Thanks a lot my fellow addicts, i trust experience over book knowledge any day. That's how I know I'm in the right place

 

[kleinerkiffer]

Tramadol is already in my system when I induct suboxone, will it cause PWD

It's possible, most likely depends on the dosage of both the tramadol (btw, going above 300 mg a day can cause seizures) and buprenorphine.
The precipitated withdrawal isn't caused by the naloxone literally kicking off opioids from the opioid receptors but because buprenorphine is only a partial agonist instead of the full agonist you're used to, which leads to less receptor activation which in turn causes withdrawal symptoms.

tramadol is not an agonist or partial agonist

Tramadol or better it's metabolite Desmethyltramadol is a full mu-opioid receptor agonist

 

[Shant]

The precipitated withdrawal isn't caused by the naloxone literally kicking off opioids from the opioid receptors but because buprenorphine is only a partial agonist instead of the full agonist you're used to, which leads to less receptor activation which in turn causes withdrawal symptoms.

So what's the role of the naloxone there? Because you can take the naloxone on its own (no buprenorphine) and get PWD that way.

Also, tramadol has a pretty long half life compared to heroin, no? If I take 150mg at 8am today, when would you reckon it's safe to drop the suboxone?

PS- I know someone who insists that tramadol 'slips through the cracks'. He says it even gives him pain relief despite being on 16mg of suboxone daily. Any reason to believe that's true? What exactly is it about tramadol that's so different? I understand it wasn't even classified as an opiate until several years back (probably more than that, but still...)

 

[Shant]

I typically need at least 16 hours to induct on heroin (half a gram per day habit). 18 hours I find to be very safe. Just wondering how to compare the tramadol with that...

 

[kleinerkiffer]

What exactly is it about tramadol that's so different

It's both an opioid and SNRI. The SNRI effect most likely causes additional pain relief (if you check out this post https://www.bluelight.org/xf/threads/⭐️-biology-pharmacology-and-drugs-101-⭐️.872859/#post-14528970 you can see that both serotonin and norepinephrin play a role in nociception)

what's the role of the naloxone there?

It's so people can't abuse/inject it, because taking a lot/injecting it would increase the bioavailability of naloxone, which is an opioid receptor antagonist, resulting in withdrawal. With a normal dose the naloxone usually doesn't play a huge role due to low bioavailability.

tramadol has a pretty long half life compared to heroin, no?

Tramadol itself has a half life of around 6 hours while desmethyltramadol has a half life of around 9 hours.

when would you reckon it's safe to drop the suboxone?

There's something called COWS score, which should help you decide when to take the sub https://www.mdcalc.com/cows-score-opiate-withdrawal

 

[Hodor]

So what's the role of the naloxone there? Because you can take the naloxone on its own (no buprenorphine) and get PWD that way.

The idea behind adding naloxone to opioids is to make them less attractive to inject.

Basically, naloxone's oral bioavailability is like 1%, while IV bioavailability is by definition 100%. So if you eat your pills as intended, virtually none of the naloxone will make it past the liver, and the only thing you'll feel is the opioid agonist. If you inject it, you'll suffer precipitated withdrawal because the naloxone's antagonism will overpower the active opioid's agonism.

While the practice does not seem to be commonplace in the US (with the exception of the blockbuster drug suboxone), in Germany the popular opioid tilidine is usually sold as a combination drug with naloxone ("Valoron N") to decrease abuse. Ditto for oxycodone, which is available in a naloxone combo called "Targin". I believe in North America, it is mostly done with pentazocine ("Talwin NX").

In all these cases, the combination makes perfect sense, because the naloxone can easily kick the tilidine/oxy/pentazocine off the receptors. With suboxone, the issue is a little more iffy - buprenorphine itself binds to the receptors just as strongly as naloxone, so the naloxone can mayyybe blunt the initial euphoria of a bupe injection to some extent by competing for the same receptors, but not send you into withdrawal. That's why a lot of people are saying that the primary reason for adding the naloxone was less about deterring people from injecting it, and mostly about having a patentable "new" drug.

 

[Crowsonator2008]

So what's the role of the naloxone there? Because you can take the naloxone on its own (no buprenorphine) and get PWD that way.

Also, tramadol has a pretty long half life compared to heroin, no? If I take 150mg at 8am today, when would you reckon it's safe to drop the suboxone?

PS- I know someone who insists that tramadol 'slips through the cracks'. He says it even gives him pain relief despite being on 16mg of suboxone daily. Any reason to believe that's true? What exactly is it about tramadol that's so different? I understand it wasn't even classified as an opiate until several years back (probably more than that, but still...)

Tramadol would be the last thing on my mind if I got 16mg of buprenorphine a day.

 

[losangeles1993]

I think your much safe if you just jump from Heroin to Suboxone to be Honest...you would only have to wait 18 to 22 Hours the longer you wait the better you'll feel in my opinion...what's with the tramadol why you so Keen on taking it for?

 

[mostly-human]

The precipitated withdrawal isn't caused by the naloxone literally kicking off opioids from the opioid receptors but because buprenorphine is only a partial agonist instead of the full agonist you're used to, which leads to less receptor activation which in turn causes withdrawal symptoms.

This is a bit weird / wrong. The Naloxone isn't the issue and is basically a marketing gimmick. However, the bupe has extremely high binding affinity and most certainly does kick off and block the full-agonists that may be in your system and that is what causes withdrawals.

 

[Shant]

So the buprenorphine has a stronger "kick out of the receptors" function than the naloxone? That's exactly the opposite of how i learned. I understand you guys are saying that most of the naloxone gets lost during first pass, but suboxone comes in films which dissolve sublingual (transmucosal?) so you're gonna get a lot more of the naloxone that way.

Also, the naloxone is very effective at preventing you from getting high in the first place, post induction. That feature, frankly, is far more valuable (long term) than mild relief the buprenorphine gives you. It's the reason subutex (only bupe, no naloxone) sells for more on the street. Customers won't pay as much if it's suboxone. So I think it's a bit harsh to call naloxone a marketing gimmick, no?

 

[Shant]

I think your much safe if you just jump from Heroin to Suboxone to be Honest...you would only have to wait 18 to 22 Hours the longer you wait the better you'll feel in my opinion...what's with the tramadol why you so Keen on taking it for?

Well, the reason for this is because I'm trying to "stick the landing", so to speak. Meaning I want to induct as painlessly as possible. If I go straight from heroin to suboxone, I need about 16 hours. If I do have PWD at 16 hours, it only lasts an hour or two anyway and I'm straight. The problem is, it's not an exact science. Last time I waited a full 24 hours and didn't even feel that badly. I was sure I wouldn't get PWD. Took 8mg and sure enough I got a nasty bout of PWD. Lasted about 8 hours. Conversely, there are times where I feel horrendous at 13 hours and can safely induct.

Tramadol, if I do it correctly, should allow me to avoid all that drama. I switch from heroin to tramadol for a day, maybe 2. Let the heroin really leave the system. Unlike tramadol, heroin can often consist of several opiates. I test dirty for oxycodone, hydrocodone, codein, and morphine. All from the same dope. You've got multiple half lives to calculate, etc...won't have that issue with tramadol. After 2 days of it, I figure the wait should be about the same. Maybe closer to 20 hours. But those 20 hours will be a lot easier than the 16 hours of no heroin.

I hope that makes sense, I realize I can ramble a bit...especially when the topic of drugs comes up. It's like finally being around people who speak english for the first time in years after getting stuck on an island where nobody understands you. Also, I took my ambien 15 min ago, so that always makes me chatty. Thank you guys...

 

[losangeles1993]

Wow I have never thought about that...that's actually a good idea ..I'm guessing it would work with any pill not just tramadol tho right?

 

[Shant]

Yes but Tramadol is an especially good candidate for that. Unless you're on tramadol long enough to get the SSRI benefits, the kick is very painless. But if you're on it for a while, for a couple months lets say, and then you try to walk off it can be especially nasty. And there's the seizure risk. So you really have to know what you're doing. Also, there are people who insist that it won't trigger PWD the way other opiates do. I guess I'll only know the answer to that after I try it for myself. I'm gonna initiate all this tomorrow. Will let you know how it goes.

 

[kleinerkiffer]

This is a bit weird / wrong. The Naloxone isn't the issue and is basically a marketing gimmick. However, the bupe has extremely high binding affinity and most certainly does kick off and block the full-agonists that may be in your system and that is what causes withdrawals.

Well, I only know that one of my profs once during a lecture said that while we always say that for example bupe kicks off other opioids from the mu-opioid receptor because of its high affinity it's not really what's happening on a molecular level. I think it's more about probability/statistics of binding than bupe ripping off other opioids from the receptor.
But bupe seems to occupy the mu-opioid receptor for quite a while thus blocking other opioids from binding. Because of that you most likely can't get high by taking say heroin while on a high dose of bupe

 

[Fuckupnomo]

I saw the title of your post and immediately clicked- my experience is very similar, just swap morphine in place of the heroin.
Can I ask, why vivitrol instead of staying and living on suboxone?

On a side note, I don’t know much about vivitrol at all, I had to read about it when I saw it in your post- also I’ve been on suboxone for over 6 years.

Thx

 

[Fuckupnomo]

I also should have included that yes I have the experience you’re talking about - I went from tramadol - which was the only opiate (or whatever it is) in my system- onto suboxone. And before tramadol it was morphine - similar to your heroine.

 

[mostly-human]

Well, I only know that one of my profs once during a lecture said that while we always say that for example bupe kicks off other opioids from the mu-opioid receptor because of its high affinity it's not really what's happening on a molecular level. I think it's more about probability/statistics of binding than bupe ripping off other opioids from the receptor.
But bupe seems to occupy the mu-opioid receptor for quite a while thus blocking other opioids from binding. Because of that you most likely can't get high by taking say heroin while on a high dose of bupe

Out of curiosity, how do you explain bupe sending you into instant PWDs?

 

[kleinerkiffer]

Out of curiosity, how do you explain bupe sending you into instant PWDs?

That's a good question, I'm afraid I can't answer. I guess there's not much backing up what I claimed then

 

[Shant]

I saw the title of your post and immediately clicked- my experience is very similar, just swap morphine in place of the heroin.
Can I ask, why vivitrol instead of staying and living on suboxone?

On a side note, I don’t know much about vivitrol at all, I had to read about it when I saw it in your post- also I’ve been on suboxone for over 6 years.

Thx

Great question. I have a bit to say about this so I'll try to keep it pithy

Because, as a general rule, it's always better to be on fewer drugs than absolutely necessary. Suboxone has the buprenorphine and the naloxone. The Bup being the far more concerning of the two (long term at least) in terms of side effect profiles and even psychological state (mood level fluctuations by way of opiates' effect on neurotransmitters). I wish more people...no...more DOCTORS understood that you don't want to be on suboxone long term. Google the horror stories. My recommendation is to do suboxone for a couple weeks,, maybe a month. However long it takes before you can finally sleep decent again at night. THen switch to vivitrol to ensure you don't break and call your dealer for those fragile next few months. Maybe up to 6 months. By then, you're as clean as you're ever gonna get. You honestly won't need the buprenorphine after that anyway, and because you're on it such a short time you can walk off from 4mg and barely feel a thing in my experience. Long term bup users, on the other hand, have a horrendous time kicking it in my experience.

So you've been on suboxone 6 years? What's your dose? Has it been fluctuating much or decreasing over time or have you been on the same dose the whole time?

 

[Shant]

I also should have included that yes I have the experience you’re talking about - I went from tramadol - which was the only opiate (or whatever it is) in my system- onto suboxone. And before tramadol it was morphine - similar to your heroine.

Wonderful, then you have the exact experience I'm looking for. How many mg of tramadol were you taking? How long did you stop taking em before you inducted suboxone? And did you experience any PWD? Also, did you ever try taking tramadol while already on suboxone? If so, did you feel it working? Thanks