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  • AADD Moderators: swilow | Vagabond696

methadone, buprenorphine and other opioid pharmacotherapies

footscrazy said:
I don't know for sure, but I think buprenorphine would actually have a higher affinity than naltrexone. In theory, it seems possible that you could be on naltrexone and suboxone at the same time without withdrawals, because the bupe would out compete the naltrexone - does anyone know this for sure? If that was the case though, there would be no point taking naltrexone at all. My bupe doc has also said I can't be on naltrexone and sub at the same time though.
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I was researching this topic recently, there have been studies which determined using naltrexone during a bupe taper had a better long-term outcome for relapse rates. I read many times that "in theory" if you have naltrexone in your system, buprenorphine should have a higher affinity, however they will continue to "fight" for lack of a better word, for the receptors, causing minor discomfort. I wish I hadn't had as much valium because I did research this recently.

Baclofen worked for me too when I was serious about cutting back on my alcohol intake. Doctors are happy to prescribe it too, even though it's a GABA agonist, it's not a GABA-a (?) which is what gives us the pleasurable effects, it's a GABA-b (?) agonist which just has the muscle relaxing properties with no pleasure. However footsy, please be aware that the withdrawals are just as bad as any other GABA agonist. I was once away from home for a couple of days and forgot to take my baclofen with me - not thinking much about it at the time - later during the day, I started to get a terrible headache, my whole body started aching, I couldn't eat and my mate told me I looked like I was dying. I seriously could barely do anything, it was very unpleasant. After that episode I decided to taper down quickly and get off it as soon as I could. My doctor never mentioned this to me, but after a little research on the 'net, I learned that it's very similar dependance and withdrawal wise to benzo's. Be careful.
 
^Thanks for the info opi8. When I was prescribed baclofen I did research it and realised it was associated with the dependence and withdrawal of benzos. Like you, I had never been told this by my doc. It really pissed me off. I feel like it's a doctor's duty to tell you of such a significant side effect and negligent to dismiss it. I brought it up with my doc next time and he was unconcerned, brushing it off by saying that was only associated with months of use. But it was fully understood between us that this WAS a longterm treatment for me :/

Anyway, given I'm aware of the dangers I haven't had too much trouble with it, also, I'm on a fairly low dose so tapering hasn't been too much of a struggle, though I can feel it. I have been caught out sometimes though and it is awful, waking up fairly recently dopesick and feeling the wd effects of that was really miserable. I get a feeling of inner anxiety and restlessness, which is so unbearable.

I've found that in Vic, only specialist addiction docs/psychiatrists will prescribe it usually, in Qld it was almost unheard of and a struggle to get, and in NT it was easiest, with a regular GP happy to prescribe it. Though I have used the severe wd as a way to get it prescribed by a GP in Vic it(seriously, not scamming) but she wasn't happy about it. I think because it's not a listed use for it, alcoholism, so scripts written have to be private.
 
I take suboxone films the usual way, under the tongue. Lately though they've been causing me a lot of problems - they're really hurting my mouth, and the area they touch under my tongue is so sore and inflamed. I took a week off them recently and the area healed up a lot - but within one day of using them again the problem was back and worse than ever. I can't continue to take them this way - it really hurts, and is even making talking and eating a real pain. My doc has recommended trying them against my cheek, which I haven't tried yet. The effectiveness of this method seems to vary, from what I've read.

I haven't had a lot of luck finding much information about this problem. Has anyone heard of or experienced something like this, and has anyone tried dosing the films against the cheek?
 
Never heard anything like it. This may be a case where subutex could be prescribed instead of suboxone. It's most likely a) the naloxone or b) whatever is in the strips. To my knowledge, subutex is still in pill form, but I am not sure of that. I do know of people who got swtiched from the bupe/naloxone to just bupe because of the side effects naloxone was causing. Maybe you could mention that to your doctor.

I'm only trying to be helpful, I know most doctors avoid being helpful at all costs.
 
Yeh I've had something similar with the mouth pain but I was using a bupe patch sublingually instead of transdermally, so it's prob just abrading in my case, maybe you have a sensitivity to some of the ingredients in the strip?.

I switched to buccal at that point and although it wasn't quite as effective it still worked reasonably well.

I suppose you could try dissolving the strip in a very small amount of water and dropping it under your tongue. I've had good results using a nasal solution also.
 
Thanks for the responses guys. I've read about dissolving the strips like you mentioned bizza so I might give that a go. I'll talk to my doc too, he's actually not too bad as docs go. I've got a few tablets left over too, and snorting them works ok.
 
Both me and my girlfriend have noticed that our teeth hurt when using suboxone.. they feel brittle and sensitive
 
I'm on 32mg bupe, I gave it 28 hours and was yawning, getting teary eyes and other withdrawl symptoms, in short I wasted a LOT of oxy for fuck all rush.
At least I didn't get sick, but now I am going to have to go to the chemist late the next night, which will be suspicious
 
I cut an 8mg piece of bupe in half and had it. Guinea pigging myself sort of.
No feelings or effects. No sickness, no reduction in the high i got if you can call it that, it helped me relax even nod off a bit tbh
I am drinking, had 8 5% beers have alprazolam/diazepam/temazepam/clonazepam/mitrazapine/fluoxetine and oxazepam as well in my system, I feel like going to the toilet for some reason (#2). Some of these myths are wrong about using while on bupe and its my only slip up while ive been on it. Just wanted to find out for myself
Should have waited at least 32 hours until I had a runny nose and aching muscles before using the oxy - hindisght 20/20
I will go to the chemist at the normal time, I'm putting them on my teeth and spitting them and getting some dope (They don't watch me take it) I just shove them all in usually under 4 different sides under my tongue say thanks and walk but I have to pick up my weeks worth of rivotril tomorrow.

[edited to make numbers/names/%'s right]
 
brainless said:
I'm on 32mg bupe, I gave it 28 hours and was yawning, getting teary eyes and other withdrawl symptoms, in short I wasted a LOT of oxy for fuck all rush.
At least I didn't get sick, but now I am going to have to go to the chemist late the next night, which will be suspicious
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Yeah it's such a waste if you've got a decent amount of bupe on board. For high doses like that I would have had to wait maybe 72 hours to get worthwhile effects, it's different for everyone though. On lower doses can get away with much shorter period of time.
 
brainless said:
I'm on 32mg bupe, I gave it 28 hours and was yawning, getting teary eyes and other withdrawl symptoms, in short I wasted a LOT of oxy for fuck all rush.
At least I didn't get sick, but now I am going to have to go to the chemist late the next night, which will be suspicious
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I know you didn't bump the thread, but it's 2 years old and you're talking about two completely different drugs: buprenorphine and oxycodone, the thread is about methadone and heroin.

65mg methadone for ~3 weeks, before that I started at 30mg and went up 5mg every other day. There is a gram sitting and gazing at me in the most seductive way. How much of this will need to be done at once to minimize waste and maximize feeling absolutely ANYTHING?
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It's not safe to assume that you will have a high tolerance and just go shooting an enormous amount of heroin just because you're on methadone. Who knows what your tolerance is like or how pure your heroin is. There is no magic amount that will be good, nor is it safe to say that there is. I wouldn't bother using it at all on that much methadone if I were you, there's really not much point. Search for saturation of receptors and you'll find out why. My advice would be to save it until you've got your dose down to a reasonable level.

Any further opiate related posts should be placed in their proper respective threads, such as the New and Improved Smackie Thread, or the Methadone, Buprenorphine and other Opiod Pharmacotherapies thread,
 
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fuckin looks like i will be getting onto the bupe program....thats if i can pull a clean piss test and i've had my final taste of meth tonight,so will have to wait atleast 4-8 weeks to be able to pull a clean piss test.....goodbye poppy seeds hello suboxone! wish me luck!
 
You need to piss clean to get on bupe? That doesn't make a lot of sense. I needed to piss dirty :\

Just get the lowest dose you can, probably the lowest they'll give you is 8mg. But even then if you get takeaways break/cut it in half or in quarters, or even less, and see how you go. You'll probably be glad to have a stash of bupe anyway for emergencies. I really don't think there's much benefit on going on high doses. Usually what will hold you is much lower than they prescribe. I know some posters on here vouch for very low doses of <1mg due to the action of one of its metabolites working more effectively at very low doses. But, I have also seen posters that choose higher doses because it's more effective for reducing cravings, and also preventing use, as it'll block the effects of other opies for longer. Bupe was such a cunt for me to come off though, even at a low dose. I would that possibility into consideration when choosing your dose, and try and keep it as low as possible.
 
^ this.
If you're expecting any kicks (ie pleasurable effects) from bupe, you'll quickly realise they're fleeting - if at all.
IMO tiny doses, then taper off with it. That is the value of buprenorphine.
In the words of Chubby Checker; "How Low Can You Go?"
Less is more. No bullshit.
 
I wish I could get a straight answer damn. I decided last night that I quit. I finished my last pill and went to bed before midnight i think. I have three and a half suboxone strips my boyfriend gave me. Its 9 am here now so how long should I wait before eating a sub? I'm already having chills and sweating. .

Questions I need answered:
1. How long to wait b4 taking one
2. Will it stop all of the symptoms?
3. What happens when I'm out of suboxone?
4. When do I take the second?

I do NOT wanna turn back to heroin so please help.
 
Finished your last pill? What pill? There's no way to answer this without knowing what opioid you took and at what dosage. Even then, at what point you can take sub and not be put into precipitated withdrawals can vary wildly from person to person.

From what I can gather, it's been about 9 hours since you last used. That's likely too soon to take sub. A general rule I followed was that waiting at least 12 hours was necessary for opioids with shorter half lives such as heroin or oxy, and I'd wait at least 24 hours after longer acting opies such as those in poppy seed tea. But, usually people suggest that when you start feeling moderate withdrawals you'll probably be ok to dose sub. I've never actually experienced precipiated withdrawals so it's hard for me to say how soon is too soon.

Will it stop all your symptoms? Another one that can't be answered definitively. It's very likely to make you feel vastly better though. As for what happens when you run out, that's something you'll have to work out yourself. I would suggest taking the lowest doses of suboxone possible to make it last as long as you can. How many milligrams are your strips? Cut your strips into smaller pieces and see how you go on the smallest dose you can - less than a mg. As discussed above, smaller doses can be more effective than larger ones. This will also make tapering easier. It is possible you could do a rapid taper with your 3.5 strips that will be manageable if you keep your doses low. You usually dose sub once every 24 hours too, but if you have to taper with just the strips you have, try spacing out the doses further each time, or even dosing once every 48 hours.
 
^ yup.
Agree with what foots said (with as little information as you've given us).
Take as little as will hold you (from withdrawals).
Even if what you take isn't fully satisfying - try to work with that.
Each little chill of withdrawal is a step towards freedom.
So long as you don't have any major symptoms of opiate withdrawal (yawning, nausea, restless leg, general physical discomfort) - try to stabilise on as low a dose as you can.
Bupe is active in micrograms - so don't feel you need to start huge.
You might need a hefty dose to keep you out of withdrawal - or you might feel quite functional on 1,2 - even say, 0.2 mg of bupe. Without knowing your tolerance, there is no way we can definitively tell you how to structure your taper.
But; and this is the important answer to your question
mdmazing_ said:
3. What happens when I'm out of suboxone?
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When you're out of subs - or ready to stop taking it (having tapered effectively...!) you can avoid a lot of the classic full-agonist withdrawal symptoms and go about your daily life.
You have to be motivated, determined and remind yourself why you're doing this - but it can be fairly painless compared to going cold turkey.
Personally, I would experiment with the lowest dose imaginable (like, stupidly low) and work your way up from there - if you need to. Bupe is fucking potent stuff, and you might be lucky and find that your three and a half strips last you long enough to see the full agonist (heroin? Pain pills?) out of your system, so you can wean off the agonist/antagonist bupe - which is a lot less drastic.

Nobody here can really give you a straighter answer than that, because everybody's habit/metabolism/drug of choice is different - and we'd only be guessing.
Stay firm in your commitment to be dope free, remember that the discomfort won't last forever - and at the end of it all you'll be out of the cycle of addiction.
Meds such as clonidine are a godsend too, if you can get a doc to script you some; they help immensely with restless legs and can help you get some sleep.
All the best!
There is a wealth of information on this site about kicking, and how to do it safely, comfortably and effectively.
Lots of knowledgable, compassionate people too :)
 
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