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Opioids Breaking Through Suboxone - Then what?

A

aarondank

Bluelighter
Joined
Apr 30, 2013
Messages
47
I am well aware that attempting to break-through suboxone with high-doses of opiates is extremely dangerous, and can easily lead to an overdose.
Thus - I have steadily reduced my suboxone dose over the past week, in preparation for a few fentanyl/fentanyl-analogue pressed pills I will be receiving.

I have used this same product before, and followed the same regimen, and succesfully broke-through the suboxone, and felt the effect of the pressed pill.

My question is:

Once a user has broken through the suboxone with a higher-binding opiate (i.e. fentanyl), will the user be susceptible to experiencing ANY/ALL opiates?

In other words, after taking the fentanyl, would other (weaker) opiates now be able to have an effect, or would the suboxone still block them?

Does fentanyl REMOVE all traces of the buprenorphine binded to one's receptors, or is it a temporary break-through?

If i take fentanyl today, and successfully break-through whatever remaining suboxone is on my receptors, could I use a weaker opiate tomorrow, because the fentanyl knocked the bupe off my receptors;
or does fentanyl break through - and then bupe reattach?

I hope this question makes sense. Thank you!
 
Yeah - I was hoping not, but I suspected that to be the case. I wish I had a better understanding of the neuro-chemistry behind it. You'd think once something is knocked off a receptor it "disappears," but maybe it just waits for the stronger opioid to wear-off before reattaching... Then again, if it did just "re-attach" wouldn't their be automatic precipitated withdrawals? That's what made me think maybe other opiates could start binding to the receptors as well... Complicated stuff.
 
aarondank said:
You'd think once something is knocked off a receptor it "disappears," but maybe it just waits for the stronger opioid to wear-off before reattaching... Then again, if it did just "re-attach" wouldn't their be automatic precipitated withdrawals? That's what made me think maybe other opiates could start binding to the receptors as well... Complicated stuff.
Click to expand...

You have to view it like this, things stay in your blood until they are eliminated. That is done by the liver chemically altering them so they are not active followed by removal through urine and others. During the time the liver is working it is in your blood and thus all over your body. If you use something that fits better then they bind to the sites until they are eliminated but anything that would potentially bind is still in your blood it just "loses out" to the higher binding affinity until that substance is cleared. These substances do not bind irreversibly so they are constantly going on and off receptor sites which is why you can break through suboxone.

Lets say you have 1 suboxone in your blood but you add 10 heroin, the fact there is 10x competition for receptor sites means there is a greater chance of heroin binding which is what occurs. This is just my pieced together understanding and i cant not get a source for it as it is just my understanding of elimination half life and binding affinity.
 
I agree that weaker binding affinity opiates will not work for the entire duration of the buprenorphine, regardless if you've used a stronger binding affinity opiate to knock the buprenorphine off of the receptor. I imagine this is because even if you knock the buprenorphine off of the receptor, it will still stay present in the synapse / synaptic cleft until reuptake occurs and there is no buprenorphine left in both the receptor and the synapse. In your case, once the Fentanyl is gone from your receptors, the buprenorphine that has been hanging around and waiting in the synapse will re-bind to the receptors as they become vacant. My theory could be wrong, though. I don't have any data or evidence to back up what I said, just an educated guess.
 
All good replies - I appreciate the input. Consensus seems to be that fentanyl will not then "open the pathways" for weaker opiates to attach, but I still have some reserved curiosity.
 
i tried this a few weeks ago and almost killed myself off one bag. see i had some super strong dope, was banging 2&3 at a shot and not really getting like i should have... it was the lingering blocking effects of the sub, even though i quit taking it abt two days before this run. third day shooting guess the subs wore off, passed out in my truck w it running for abt 7 hrs off of a single bag, scary. bupe is an extremely strong blocker, as percipitated wd will show you.. if you dont believe try it lol. Basically just be careful trying to break through, you could easily break through to an od. weaker opiates wont do shit also, fent can, just very dangerous esp if you iv like most
 
I've heard from people with experience administering narcan that its really important to get them medical attention IMMEDIATELY after they come to, because if they run away, when the narcan wears (its got a really short half life) off they'll be right back in a possible O.D again. Seems to me its not really about the binding strengths, but its more so about their half life. Just like everyone else said, after whatever you use starts to wear off the suboxone will probably be waiting to re attach because its got a long half life.
 
aarondank said:
Yeah - I was hoping not, but I suspected that to be the case. I wish I had a better understanding of the neuro-chemistry behind it. You'd think once something is knocked off a receptor it "disappears," but maybe it just waits for the stronger opioid to wear-off before reattaching... Then again, if it did just "re-attach" wouldn't their be automatic precipitated withdrawals? That's what made me think maybe other opiates could start binding to the receptors as well... Complicated stuff.
Click to expand...

I think you have to see it like this, bupe has a really high affinity and slow dissociation constant, meaning that it'll take a long time to detach from the receptor and a long half life, meaning that'll stay there for a long time. So my guess is that fentanyl has a higher affinity, knocking the bupe off the receptor, but due to the short half life it'll detach pretty quickly and the bupe that's still around will bind to the receptor again.
Because of that people OD'ing on opioids with a long half life, i.e. bupe, methadone etc. need more than just one shot of naloxone, as the naloxone has a short half life, thus people will can slip into an OD again, if it wears off and the opioid is still around
 
Great feedback! You would think that one would experience precipitated withdrawals of some sort after the first use of fentanyl, if the bupe is just reattaching... I suppose if you didn't redose fentanyl or bupe, you would simply withdraw from the bupe (assuming you break through on a single fentanyl use).

Anyway - I ended up stopping the suboxone altogether (for the past 2 days) and began using heroin. The fent/fent-analogue pills I have coming still have not arrived, I'm hoping my dude comes through tomorrow. The heroin is now breaking through the remaining bupe, 48+ hours since last taking bupe; however the high is still somewhat diminished.

Fortunately, I am a sniffer, and so while overdose is still definitely a risk-factor, I think it is SLIGHTLY less than if I were IV'ing.
I appreciate all the well thought out feedback and the personal experience.

@Smellengine01 your story is terrifying. I appreciate you sharing, as I must not take this venture (or relapse) lightly, I may be risking my life.
I feel a little safer that I'm at least off the suboxone, as opposed to using ONTOP of suboxone.

I will have to start very slowly with the fent/fent-analogue presses whenever I get them, as none of us know the exact analogues or dosages present in the pills.
They are pressed to look like 30mg oxycodones (white oval, M BOX imprint), and so the intended dose is presumed to mimic 30 mg of oxycodone; but any black-market pressed pill can vary in dosage, and many people have reported that they feel much stronger than a real "roxy."

Stay safe everyone, and informed - and I will do my best to do the same!

Anyone have an argument for why they think fentanyl DOES permanently knock-off bupe, freeing one's receptors to bind to any opiate of his/her choosing? Lol maybe there isn't one, but this has been a very interesting / thought-provoking thread. Thanks!
 
aarondank said:
Great feedback! You would think that one would experience precipitated withdrawals of some sort after the first use of fentanyl, if the bupe is just reattaching... I suppose if you didn't redose fentanyl or bupe, you would simply withdraw from the bupe (assuming you break through on a single fentanyl use).
Click to expand...

Imo precipitated withdrawal is because you are dependent on a full agonist and while the bupe will replace it the intrinsic activity is less than with a full agonist, so while all your receptors are saturated they aren't activated as much.
If you take bupe and only take fentanyl for one time you'll maybe get high, but don't ecperience precipitated withdrawal as you're used to the bupe and the lower intrinsic activity
 
Damn good explanation! I suppose the action of precipitated withdrawal is when bupe "kicks" another opiate off the receptors... So once the fentanyl wears off, the remaining bupe gradually reclaims the receptor sites. However, if you ingest heroin, and thirty minutes later ingest buprenorphine, the bupe literally rips the heroin molecules off the receptor sites = precipitated withdrawal.
 
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