Bupe Going from Suboxone back to full Opiates for severe pain / Need plan

[devil_dog_1972]

Hi Everyone,

I was forced to switch to suboxone 8 months ago for severe pain. This was the U.S. governments solution to all the Veteran ODs they caused by passing out opiates like candy for years. Anyway I have been on 24mg a day of subox for the 8 months. Prior to that I was on opiates for 7 years for a couple of failed back surgeries, leg pain, etc. I've never had any problems with addiction, etc. This is purely for pain. I finally got insurance again so I can afford full opiates again. I filled my prescription today and I get 3 30mg oxycondone IR and 3 30mg oxycontin a day for the month. I get this prescription re-filled every month.

I took my full dose of 24mg of subox this morning. I know everyone is different, tolerance, weight, etc. I'm looking for recommendations on cutting over. I have a ton of subox left. My main objective is to achieve maximum pain relief. After years of being on opiates the euphoria typically isn't much for me but you could use the getting high scale if you don't have chronic pain and have real world experience doing this. I keep reading going 3-5 days without subox is usually enough and then some people say the subox lingers for months. I don't need to worry about wasting money because again I this script refilled monthly. I'm more concerned with the least amount of pain and getting off this subox crap. I think this drug is probably great if you have a serious heroin addiction but not for my severity of neurological pain. Any comments or suggestions appreciated.

 

[burn out]

Suboxone does help with pain but it is not good for "breakthrough pain". If you took 24 mgs its going to be a while before you can feel normal doses of oxy, like 5 days or more.

 

[The Doc.]

Jeez 24mgs no wonder your not getting relief that's a huge dose something like 2 mgs spilt in to smaller doses a few times a day would have worked better but still for some pain its just not enough. Do you take it once a day? If tsking bupe for pain it has to be done every 4 hours because although it stays in your system 36 hours its only effective on pain the first 4 hours after its taken. Most pain patients on bupe take doses like 0.2mgs every 4 hours so the receptors arnt full and you can dose every 4 hours letting fresh bupe onto the receptors each other time.

If your going onto pain Meds Your going to have to taper your Suboxone down to 1mgs over the course of a few months then jump off for a few days. After you do this you should be able to feel pain meds but with your tolerance now if you stopped the Suboxone now at 24mgs you would be waiting months to feel pain meds properly and probably at least a week to even feel them slightly. At 24 mgs the amount if oxycodone or vicodin you would need just to take away withdrawal would be massive and more than most legitimate doctors would be willing to prescribe. Not many doctors I know are willing to prescribe 400mgs or more of oxycodone a day. Do the taper go down by 2mgs every 5 days until your down to 1mg then you'll be better off to start pain meds.

 

[adder]

I think buprenorphine is an effective painkiller mostly due to its metabolite, norbuprenorphine, effects. Norbuprenorphine likely dissociates much faster from mu opioid receptors, it's also much less lipophilic, so even though it has a long half-life similar to buprenorphine, the more time passes since the dose, the higher its concentration will be peripherally and lower centrally. Buprenorphine on the other hand is very lipophilic, so once it passes through the blood-brain barrier, it should stay much longer than norbuprenorphine in the brain. I guess that's the reason why the pain relief from buprenorphine is relatively very short compared to its long half-life and for the same reason at very high doses there is less pain relief than at low doses (much more buprenorphine than norbuprenorphine bound to mu opioid receptors in the brain with a lot of unbound buprenorphine in reserve, so in reality norbuprenorphine from the next doses cannot bind anyway). I don't really take buprenorphine's and norbuprenorphine's affinities at mu receptors into account, because on the contrary to the previous results it seems that they may actually both have a similar affinity (source). If norbuprenorphine had a much lower affinity than buprenorphine, I doubt it would be possible to feel strong opioid effects even at low doses. The only problem with norbuprenorphine would then be its secondary amine drastically affecting pharmacokinetics.

Anyway, that hardly helps you, doesn't it? Taking 24mg a day now, your best option is to start decreasing your dose as you've been already advised and to start splitting your dose into multiple doses. However, I think you may still feel some additional pain relief from oxycodone once you go below 8mg of Suboxone a day, but it certainly won't work as it would taken alone and without tolerance built up on buprenorphine, and I doubt it will be of much help until you go down to 2mg a day. If you decided to dose oxycodone on top of buprenorphine, you'd have to work out how to space oxycodone and buprenorphine doses enough in time, so you suddenly don't feel worse at some point with buprenorphine forcing oxycodone out of receptors. I remember one person posting here that he got precipitated withdrawal a few days after taking hydromorphone on top of buprenorphine for a few days, I don't really know how it could have happened though. Perhaps his dose of buprenorphine was low enough for hydromorphone to bind and once he stopped taking hydromorphone, he simply experienced regular withdrawal because there was less opioid effect overall. Thus it may not be a good idea to add oxycodone until your Suboxone dose is low like 2mg at most.

 

[Erikmen]

Have you thought about methadone?
I´m not quite sure if that is a better option.
It´s stronger though.

 

[Fire&Water]

Doctors that prescribe 24 mg's daily bupe' need to have their license yanked.

 

[ThaDudeAbides]

Personally if I had those oxy scripts, I'd keep the bupe on reserve. I've had/do both and find oxy to help with my pain quite a bit. The most bupe I was on was 8mg a day. 24mg is overkill. Has it made you sick? I took more than 8mg and got sick as fuck.

If you didn't have problem with abuse (you were addicted/tolerant, you simply used as directed) than I would try to use as little oxy as possible to help with your pain. It sounds like you got a good mind about self control.

I still have some subs on reserve if needed.

I also agree it's going to take 5+ days or more OFF bupe to feel anything from oxy, possibly longer. 24mg a day is a lot IMO. I agree that DR should have their licensed revoked.

 

[EarthBounded]

Jeez 24mgs no wonder your not getting relief that's a huge dose something like 2 mgs spilt in to smaller doses a few times a day would have worked better but still for some pain its just not enough.

I have seen you say this before, I take subs 8mg in the AM 4mg in the PM. I actually tried splitting it up into 2mg every 2-3 hours but it didn't help my pain much, can you give a quick explanation on this I want to use subs to the best of my advantage, I had leg surgery 4 months ago and my leg wont recover or it feels like it wont because of hypersensitivity.

 

[The Doc.]

Well your dose is still really high and you also have to let your body become accustomed to the smaller doses multiple times a day instead of one big dose. But with a dose like 12 mgs a day splitting up the doses won't make much of a difference since you are filling up all your receptors right away,not leaving room for fresh bupe to attach to the receptors and convert to the full agonist metabolite we call Nor-Buprenorphine which is what is shown to kill pain the best. When large doses are used no room is left on the receptors for the conversion to Nor-Buprenorphine to take place and another problem with filling up all your receptors with huge doses is when you dose again 3 hours later you notice no difference because its only extending the duration of the drug. With small doses like 0.2-0.5mgs by the time you take your next dose 4 hours later most of the Buprenorphine has been processed leaving room for a fresh dose to attach to your receptors and convert more of the bupe to Nor-Buprenorphine once again.

So basically its best to use small doses so you leave room on your receptors so the next dose can attach more fresh bupe for another 4 hours or so. Also like i said using smaller doses gets more bupe converted to Nor-Buprenorphine which kills pain better than if the buprenorphine never underwent the conversion.

 

[EarthBounded]

Well your dose is still really high and you also have to let your body become accustomed to the smaller doses multiple times a day instead of one big dose. But with a dose like 12 mgs a day splitting up the doses won't make much of a difference since you are filling up all your receptors right away,not leaving room for fresh bupe to attach to the receptors and convert to the full agonist metabolite we call Nor-Buprenorphine which is what is shown to kill pain the best. When large doses are used no room is left on the receptors for the conversion to Nor-Buprenorphine to take place and another problem with filling up all your receptors with huge doses is when you dose again 3 hours later you notice no difference because its only extending the duration of the drug. With small doses like 0.2-0.5mgs by the time you take your next dose 4 hours later most of the Buprenorphine has been processed leaving room for a fresh dose to attach to your receptors and convert more of the bupe to Nor-Buprenorphine once again.

So basically its best to use small doses so you leave room on your receptors so the next dose can attach more fresh bupe for another 4 hours or so. Also like i said using smaller doses gets more bupe converted to Nor-Buprenorphine which kills pain better than if the buprenorphine never underwent the conversion.

Awesome info, I am going to start a new thread with further questions!

 

[The Doc.]

Awesome info, I am going to start a new thread with further questions!

Cool yea glad you understood it sometimes it hard to explain with writing.

I find 2-3mgs a day works best for my herniated discs right now I take 0.5mgs 4 times daily sublingually. Before this I took 0.3 three times daily (1mg) but upped it when I hurt my back again a couple months back but not because of tolerance or anything. Bupe is great because it doesn't raise your tolerance the same way as other opioids do I know someone who has taken 2mgs daily for almost a decade and he hasn't felt the need to raise his dose yet.

 

[devil_dog_1972]

Thanks for all the replies. I've got myself down to 4mg a day and will go down to 2mg for a few days before switching over.

It's sad that these doctors don't know how to prescribe subxone for pain. This apparently is stemming from the VA prescribing too many opiates over the last 10 years or so. Since they have had so many ODs they are now recommending subxone and apparently are not educating their doctors properly. The doctor that was prescribing mine was an addiction doctor not a pain doctor. Typical government rushing to cover their asses. Even sadder is that the ODs have mostly been combat Veterans that suffer from PTSD and not chronic pain patients. Don't get me wrong I'm sure many of these patients have pain but when your suicidal the worst thing a doctor can do is give you 200mg a day of strong opiates in 30 day quantities. They are doing the same thing for benzos. They are just flat out refusing to prescribe them and stopping Vets that have been on them for legitimate reasons. Thanks again.

 

[donkeyPUNCH]

first off, thanks for your service, marine.

secondly, holy fuck that's a lot of suboxone. you've got the right idea so far though. taper off the subs and stay off them for about a week, then start on the oxy. you might not feel the full effects of them for a few weeks still, but it'll probably be better than you felt on the subs in my opinion.

 

[CfZrx]

Have you thought about methadone?
I´m not quite sure if that is a better option.
It´s stronger though.

Bump. Methadone is the top pain drug, especially for nerve pain and super duper especially used with high cbd weed imho.