Bupe Butrans Patch - Is this a good time to Quit/Jump

[timetohunt]

Background: Typical with a twist or two. Injured and got hooked. Apex of my usage was over 100mg of Oxymorphone (Opana) daily.
I would often flip my meds, being on the Opana half the month and Suboxone the rest of the time. I was the type of opiate user who got
great amounts of focus and energy from them and they eradicated my anxiety issues while I was on them. That all lasted until about 18 months ago as I could tell the positive effects were declining. They have declined to the point where my tolerance is unsustainable, and it works for almost nothing unless I dose immensely high. To not get sick I went back on sub for awhile but even at doses as low as 3 mgs I was getting bouts of terrible Serotonin Syndrome (SS) , myoclonic twitches, hours of puking bile.

As you can see I have no place left to go in the world of opiates except Methadone, and I'm not doing that.
Not knowing whether it was the Bupeprenorphine or the Naloxone causing the SS I was luckily prescribed these Butrans Patches (only 10mcg/hour).
If my calculations are correct that amounts to only .24 mg per day of bupe. I'm on my 3rd week. If I am feeling okay, wouldn't this be a good jumping dose to end 7 years of opiate merry go round madness? I just don't know how the patch jump would compare to a pill jump. The dosage seems reasonable. My last run of sub and the patches total has been maybe 5 weeks, also reasonable IMO (before that it was the Opana). So there is the question, is this an absolute perfect opportunity to get out? I typically become a mad man during withdrawal and wind up in psych wards, my longest clean time was 2 1/2 months and Ive have a month here and there sprinkled in.

Also Note: I have had some Serotonin Syndrome like symptoms while on this patch, tho it might have been a drug mix. .25mg per day and still SS symptoms ? - well I'm either super prone to SS it or its something else. Perhaps fodder for a different thread. Thanks for reading! Hope to hear some posts. BTW, a patch is a great way of drug administration , keeps you from messing with pills and you only get 4 a month. I was addicted to the Straw when I used pills.

 

[pinpoint]

I have heard of opiates causing SS when combined with other drugs that act on serotonin - but then again, people toss the term SS around like it's no big thing, so I always ask, how do you know you truly had SS? Was it self-diagnosed? It's a rather serious condition and not quite as common as the internet would have you believe.

 

[timetohunt]

There was absolutely no doubt. In one study 43% of people using sub got varying degrees of it. My bouts had myoclonic twitches, nausea, puking, and headaches. Each time I stopped sub, the nausea would stop in a day, the twitches would take a week. My physician agreed it was SS. Also a reason he knows to avoid SSRIs and SSNRIs with me. Further reading suggests its the buprenorphine not naloxone. Definitely not just throwing it around here. I don't know if there is a dosing amount threshold. The times it happened with the patch, I used other drugs. I keep a bottle of Cyproheptadine with me, as so far it's the only major known med that can defuse it on the spot (though can take an hour or two).

 

[pinpoint]

Were you using any other drugs in addition to the Suboxone? It would be very uncommon for one to come down with SS using just Suboxone. I'm not doubting you, I'm just inquiring since it seems to be a major hurdle in your efforts to get off opioids.

 

[timetohunt]

Oh, its definitely a big thing to me. I was on 8mg a long time ago and could not figure out why I was always sick. Puking sessions could last every hour for 24 hours. Scary stuff. I thought I was dieing from some unknown neurological disease. It became apparent during the times I kicked. All gone in about 10 days every time. Other opiates seem to trigger it too, but the data for me is a bit Elusive. Gives me a perfect reason to quit.

 

[timetohunt]

Actually its insanely common. Just Google suboxone and serotonin syndrome. One of the Mayo clinic studies showed 43 %.

 

[timetohunt]

One of the problems is sometimes (mostimes ?), the symptoms are extremely subtle. Mine are severe.

 

[pinpoint]

All the case studies I can find mention an adjunct therapy using SSRIs, SNRIs, tricyclics or some other medication with affinity for 5HT receptors. That's what I'm getting at - what other meds were you on when you got the SS?

 

[timetohunt]

Oh, most times I was only on my bp med. Now , hoping someone may have insight on jumping from this 10mcg Butrans Patch.

 

[timetohunt]

As far as the SS, every time, not just 2 or 3 times, more like 10, the nausea stopped in 36 hours or less and the clonus twitching was gone in 9 days or less of stopping suboxone. The twitches scared me. I also would have this thing where for example if I thought about throwing a ball, my arm would move. If I thought of playing guitar my fingers would jerk. A very annoying thing to endure. It's just not normal, and I'm trying to head for normal.

 

[Zerwas]

Oh, most times I was only on my bp med.

Bloodpressure or bi-polar? What med exactly?

Regarding the taper via patch: Theoretically this should work but I haven't tried it myself.
The dose is low enough to jump of though. Did that myself at 0,2mg with pills.

 

[timetohunt]

Liprinosil/HTCZ combo pill. 25/12.5 I think. That's for blood pressure. I do have bipolar but don't treat it with meds.

 

[timetohunt]

I was thinking of leaving the last proposed patch on for say 4 extra days. Thereby going from .24mg to 0 over the last few days. This all assuming that trace amounts will still be transferred past the 7 day script of the patch.

 

[Lucy Bookit]

I believe there is a little left after 7 days. I was on the shitty 5mcg patches a few months ago (1 per week), and I would give my used ones to my bf with no tolerance to chew on. I'm sure it might help a little, and it couldnt hurt to try.