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Opioids Weird conversation with my pain doc today..

R

rld73

Bluelighter
Joined
Jun 8, 2011
Messages
113
So I went off my meds this week and switched to a small dose of Bupe on my own.. was tired of the needle which is the only way that the Morphine and Dilaudid I was taking would work anymore.

So I talked to my doc about all this (without mentioning the needle of course) and told him that I thought that Bupe might be the way for me to go since Dilaudid and MS Contin weren't working orally for me anymore.. he said "no way"

He told me that if he switched me to Bupe that I would be in hell pain wise.. he prescribed me Fentanyl 50 Mcg patches and Oxycodone 15mg 4x a day for BT pain.. He said that if the patches weren't doing the trick by Monday that I could call his cell and he would instruct me to apply 2 at a time and update my script. Does this sound like this doctor is trying to keep me hooked or does it sound like he has my best interests in mind?

The one thing I will say is that the fact that you get 95% or so from orally taking Oxy does make me happy and not need to use the needle.. and no way I would mess with a fent patch to try to abuse it..

What do you guys think?
 
I have moderate chronic pain and loss of motion from an old broken leg. I take bupe for addiction, 8mg per day. It doesn't do much at all to control my pain. IMHO bupe is not very good for pain but maybe it is for some people?
 
Thanks for the reply.. Yea the couple days that I was taking the Subs was pretty hellatious as far as pain went. I only took 2mg a couple times to keep me out of Withdrawal until I went to see my doc today. Probably took 6mg total over the 3 day period. Funny thing is that I had read that you had to wait 36 hours minimum for Opiates to work after taking Bupe but I went about 18 hours and the oxy worked much better than expected!
 
Sounds like a reasonable plan to me, what your doc wants you to do. I've been trying to get away from IV'ing my meds too, and have been trying to get my doc to give me more or less what he's decided to give you. As long as you can keep from abusing the patches sounds great to me!
 
I think he is trying to give you a way off the needle. Pain docs tend to know when your using. Mine doesnt even look at me. He walks in says "still hurting" and thats its. Bam I get more dope than you.
 
Well this type of discussion generally isn't allowed, please see our chronic pain mega thread.

However, I think the doctor was trying to help you out. I didn't calculate to see whether he gave you an equipotent dosage of oxycodone, but the great thing about oxycodone IR is that the oral ROA is the best one so it's a great chance to get off the needle. Drugs like hydromorphone and morphine are notorious for being euphoric as hell and much more bioavailable via the IV ROA, however with your current pain management regimen, I would say that, IF YOUR TRYING TO TREAT PAIN AND NOT ABUSE YOUR MEDICATION, then give the patches and roxicodone 15mg a good month's trial. You can always ask your doctor for more breakthrough medication.

I don't think they're trying to get you hooked, they're putting you on drugs that are absorbed completely via routes of administration other than the IV-ROA. Oxycodone is like 90+ % absorbed orally, and Fentanyl is above 92% absorbed transdermally.

So please, try taking the medications as directed. There is ZERO advantage to injecting oxycodone, there aren't significant bioavailability gains like there are with hydromorphone and morphine, etc. That's one of the reasons I really like oxycodone. I don't have to tamper with it for it to work! What a concept!
 
Hobble said:
I take bupe for addiction, 8mg per day. It doesn't do much at all to control my pain. IMHO bupe is not very good for pain but maybe it is for some people?
Click to expand...

That's because you are taking too much bupe; you are taking a "blocking dosage" (anything more than 4mg sublingual daily) of bupe to prevent you from relapsing and to make sure the bupe knocks off the heroin or w/e opioid you were addicted to before if you try to using it. Buprenorphine is a very competitive partial agonist due to its extremely high affinity for the Mu opioid receptors, knocking full agonists with lower affinities, such as norbuprenorphine or oxycodone, off the Mu opioid receptors.

Norbuprenorphine is the true painkiller in Suboxone, imo, it's responsible for most of the opioid/analgesic effects obtained from Bupe. It's a full mu agonist, and is quite powerful, but it doesn't have as high of an affinity for the Mu opioid receptors as buprenorphine does, so you just need to make room for it. ;)
 
tricomb said:
Well this type of discussion generally isn't allowed, please see our chronic pain mega thread.

However, I think the doctor was trying to help you out. I didn't calculate to see whether he gave you an equipotent dosage of oxycodone, but the great thing about oxycodone IR is that the oral ROA is the best one so it's a great chance to get off the needle. Drugs like hydromorphone and morphine are notorious for being euphoric as hell and much more bioavailable via the IV ROA, however with your current pain management regimen, I would say that, IF YOUR TRYING TO TREAT PAIN AND NOT ABUSE YOUR MEDICATION, then give the patches and roxicodone 15mg a good month's trial. You can always ask your doctor for more breakthrough medication.

I don't think they're trying to get you hooked, they're putting you on drugs that are absorbed completely via routes of administration other than the IV-ROA. Oxycodone is like 90+ % absorbed orally, and Fentanyl is above 92% absorbed transdermally.

So please, try taking the medications as directed. There is ZERO advantage to injecting oxycodone, there aren't significant bioavailability gains like there are with hydromorphone and morphine, etc. That's one of the reasons I really like oxycodone. I don't have to tamper with it for it to work! What a concept!
Click to expand...

I'm sorry.. I didn't know this type of discussion wasn't allowed.. I will have to go over the rules again.

Thanks everyone for the advice.. and yes I definitely want off the needle and Oxycodone is working wonderfully orally..

*Edit* I think I see what I did wrong.. it won't happen again. I apologize.
 
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It's a grey area, pretty much all discussion about getting prescriptions from doctors is off-limits no matter how legitimate your case is.

Glad we could be of assistance. Have a great day :)
 
It's a grey area, pretty much all discussion about getting prescriptions from doctors is off-limits no matter how legitimate your case is.

Glad we could be of assistance. Have a great day :)
 
I keep seeing posts in regards to norbuprenorphine and how it's supposed to be the reason for buprenorphine's euphoric and painkilling profile. From everything I've read Norbupe looks terrible. It does not seem like anything that would be pleasant and can cause a very big response to breathing function. I would gather that Norbupe would be rather deadily by itself.

Can anyone tell me in appromixate ranges what buprenorphine is to a full agonist. For example, if somebody who uses opiates(iods) takes 80 mg of Oxy a day to be normal would they notice bupe? Lets say its 40 mg a day of Oxy would they feel the bupe?

I'm trying to figure out what is the tolerance level on average for somebody to be able to notice the effects of bupe upon dosing.


This means that norbuprenorphine will produce extreme physical side effects relative to theraputic levels of the drug--agonist activity will be a lot more present in the lungs and gut than in the brain; causing overdose by respiratory depression in the recreational dose range
 
I think he has your best interest in mind. If you decide to go on suboxone you will be labeled an addict and the door to getting legal pain treatment closes with it.
 
StartedHydro said:
I keep seeing posts in regards to norbuprenorphine and how it's supposed to be the reason for buprenorphine's euphoric and painkilling profile. From everything I've read Norbupe looks terrible. It does not seem like anything that would be pleasant and can cause a very big response to breathing function. I would gather that Norbupe would be rather deadily by itself.

Can anyone tell me in appromixate ranges what buprenorphine is to a full agonist. For example, if somebody who uses opiates(iods) takes 80 mg of Oxy a day to be normal would they notice bupe? Lets say its 40 mg a day of Oxy would they feel the bupe?

I'm trying to figure out what is the tolerance level on average for somebody to be able to notice the effects of bupe upon dosing.


This means that norbuprenorphine will produce extreme physical side effects relative to theraputic levels of the drug--agonist activity will be a lot more present in the lungs and gut than in the brain; causing overdose by respiratory depression in the recreational dose range
Click to expand...

If by "extreme" side effects you mean more than oxy and less than morphine roughly , yes , morphine is the most prescribed narcotic pain med in my country so when taken as advised it's actually pretty safe.

I think Jamshyd's post hits the nail on the head concerning bupe for pain , I think that's the reason temgesic and buprenex vials come in such low dosages (0.2/0.4 mg respectively).


As for your dosage questions do a little searching, I think 80 mg of oxy should put you above the 4 mg mark tolerance wise so if you are really so worried about norbupe (which you shouldn't be IMO) ; don't taper and go for that equivalent "blocking" dose.
 
I'm not worried about Norbupe. I just read a lot of information posted about Norbupe and how it's the reason for a lot of bupes more positive aspects. Which in fact all the reading I have done in regards to Norbupe is quite the opposite in that its effects are mainly on the lungs and guts.

What I'm trying to figure out in appromixate ranges in relation to tolerance is bupes ability to cause a perceived effect. If bupes ceiling is 4 mg for example(IVed for sake of discussion) that would equal 60-90 mg of morphine? I'm not sure... I'm asking that question. Now using that example a person with a 90 mg a day habit of morphine would only notice no withdrawals, no euphoria, boost of energy.

What would the average tolerance level have to be before somebody could notice opioid effects of bupe?
 
crimsonjunk said:
I think he has your best interest in mind. If you decide to go on suboxone you will be labeled an addict and the door to getting legal pain treatment closes with it.
Click to expand...

Not true...
I was prescribed subutex as a possible CPP medication 8 years ago, It helped the pain (somewhat) in the beginning, but I told him within a few weeks it wasnt going to cut it...

Edit: Although, when I received an IM of Buprenex 20 some years ago for pain relief while on holiday in PV Mexico it did work great. so maybe for occasional pain it may be a great consideration.
 
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I'm a chronic pain patient too, without opiates I'll usually hit 10/10 on the pain scale on a daily basis and am lucky if I drop below 8/10. I find bupe terrible for pain, probably on par with Darvocet or Tramadol. For my degree of pain the relief would be insignificant and I'd be miserable from the side effects. I also find fentanyl to be a disappointing painkiller - nasally it's mostly side effects and little relief, IV combined with benzos (for an minor outpatient surgery and immediately afterwards) it was moderately effective, on par with oral hydrocodone.

Of course everyone is unique and so is pain. YMMV. I think your Dr's plan sounds good. You told him you needed more relief and he responded. That's his job. If your primary objective is reducing your pain, I'd do your best to follow the regimen he laid out. If you couldnt get adequate relief from taking your morphine and hydromorphone orally, then you need stronger pain meds, or to take a break/taper down to get your tolerance under control.

I dont know your dx, but if you're likely to be in pain for an extended period of time, you really need to keep an eye on your tolerance or you may be unable to get relief from any opiate/dose. Even if you were just a recreational user, keeping your tolerance down is important. If I'm totally off base and your pain worsened as opposed to you becoming tolerant, my apologies. But I'd be very surprised if that's the case.
 
I think your doctors plan doesn't sound too bad. I agree that buprenorphine could limit you in terms of pain management, and though buprenorphine is a partial agonist, in microgram dosages, it has a similar potency in such dosages (though fentanyl has a 90% transdermal Bioavailability/absorption.
 
If you got you prescription from a pain clinic, then I would be a little sceptical. I know that pain clinics in the USA are sometimes very quick with prescribing heavy painkillers and make alot of money from people who get addicted to it.

Where i live (europe) we don't have pain clinics like that.

If you're sceptical about the advice from your doctor, go to an other for a second opinion.

But, when you take opiates for pain, it's common that the doc has to up the dose (especially when taken chronically).
When you still feel too much pain when on prescribed opiates, it's common that the doctor up the dose, or prescribe another opioid.

If the doc knows you misuse the drug by IV'ing it, here in Europe doc's won't prescribe opiates soon and give you very small refills so you can't up the dose yourself.
 
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