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How to start Buprenorphine?

T

TheChoicesWeMake

Bluelighter
Joined
Nov 20, 2020
Messages
42
Hey.
It's good to finaly be a member, after years of reading on this site. This site kept me from making many ignorant mistakes.
I'm currently on 150-200mg of Oxycodone per day.
I'm in contact with a clinic, and they want to start me up on Buprenorphine on monday. So I can't take any Oxy half of the Sunday.

So what I'm curious about is, how do they land you on the right dose?
Do they increase the dose once a day, and make you come back every day in the beginning, untill you reach a dose that works? Or do they make you stay the first day and dose every hour, until reaching a good dose?

And how do they determine when your dose is high enough? Do they keep raising dose untill i say it's enough, or do they have some way of telling?

I'm in Scandinavia. But examples from your country is fine. I'm guessing the approach is similar.

Thanks a lot for the help! Much appreciated.
Best regards
 


They say you have to be in 7 before taking bupe. I would not take oxy sunday if you want to take bupe monday. Check the scale and see. I would wait until at least 10 and take the tiniest piece.

Since you are going to a doctor, they will do it for you. I don't think you will need to come back a 2nd day. All though certain you can if you still aren't feeling well. As long as he works tuesday you should have no problem seeing him again, however if you are feeling good, then you probably won't need to.

Every place is different even in the states. There are clinics and doctors inducing subs. But generally how it works, then pick up the strips from the pharmacy.
 
Thank you for your reply! I hope I'll be able to start Monday, as I've been waiting quite a while to get a time.

But how do we land on a proper dose on Monday. First they dose with a very small dose I'm guessing. And then they wait another hour and go up, and keep going like that?
Or they just give me a dose that they think is appropriate, and send me on my way?

I'm curious to see what I land on. Obviously if the dose is too small, I'm much more likely to relapse.
So in my opinion, its's better to give a bit too much than too little. The purpose for now (at least my personal goal) is to stabilize my life, rather than start tapering down immediatly.
 
Right. You will be there for a bit. Some hours. They will give a small dose at 1st and wait like an hour to make sure you don't go into withdrawal.

Now that I think of it, knew a kid that induced from methadone was there past closing. However he went to sleep for a bit. Your doctor won't just send you on your way. Its his job to make sure you are leaving feeling good. Or come back 1st thing in the morning, etc.

And the dose will be dependent man. It really takes a few days for subs to build up. Eventually you will find what you like / don't like. Large doses can kinda backfire in a way. And with subs, less is more.
 
Thanks man. Very helpful to me.

It's good to know that he won't just send me home feeling uncomfortable.
I also read that less is more with Subs. I just don't like the sound of it hehe.

Do you think I'll land on more than 8mg per day, coming off 150-200mg of Oxy per day? I know that you can't say for certain, I'm just looking for an estimate :)
Thanks!
 
I generally found taking around 3mg the best for me. Once over 6mg it seems to work against you in a way. I once ate a full 12mg strip and felt even worse since I think most of it leaked down my throat.

We get the sublinguals here. Strips. Best way to take it is a tiny piece (1-2mg) and cut it so its shaped like the tongue vein. Put it under the tongue, and lock the tongue down so no saliva is produced and its all absorbed into that vein. If you make a lot of saliva and you feel it go down your throat, it think it gets wasted (not absorbed by anything). Only take a few minutes to absorb. Then take another 1mg or so.

You will have to play around with it. And you will probably get scripted more than you need. Once it build up into you,r body you will need less as well.
 
Mate, that's a relief to hear. I've been worried about these things. Once again, thanks for your help.
I like to hear that I'll probably get scripted more than I need. It makes me feel safe that I know that I have enough, atleast in the beginning.

I guess it's both a blessing and a curse that one can't take too high doses of it.

I think we get sublinguals here as well, both strips and sublingual pills I think.

Can I ask what drug and doses you went from, before transfering to Bupe? If it's not too personal ofcourse.

I've stocked up on a bunch of other drugs to get me through, although I don't think it'll be necessary really. But it was a good excuse to buy a bunch of other drugs at least :giggle:
 
I used to take it here or there back when they would sell the subutex on the streets. Always coming off heroin. For some reason, these seemed to work much better. They just disappeared one day and the strips came. However I do think docs still induce with subutex.

More recently I used it a bit coming off methadone. To help with the withdrawals. It did its job for the time I took it.

Oddly here they are all over the place so you can just get a bunch from your friend in 2020. But have quite a few buddies that get it scripted. They use it for heroin withdrawals. Hell, even I have ton saved up. With expiration in 2021. So will be good to have over the next year just in case. Easy to catch a habit or a friend pop up in withdrawal out of the blue. When you are really sick and able to get a sub, it will save you.

I almost did induce through a doctor about 4 years ago, but chickened out and went on methadone instead that time. My old GP scripted it too and would always remind me if I relapse to come to his office right away lol. Now that doctor I knew so well I could of slept at his office if I wanted to. So not to worry your doctor going to screw you over with this.

It should work good for oxy. Generally only people that have massive dependencies to fent have issues getting onto it. The withdrawal from fent is quite long / brutal and hard to reach several days clean, and seems to cause a PWD often. So now they have the Bernese method where you microdose the bupe at the same time. Not sure if doctors support this, but lots of info in the forums on it.

Just make sure you are sick is all.

But yeah, you really can't abuse that stuff. Has a ceiling. Also cannot IV the strips due to narcan.

Will buy you some time so you can get away from the pains of active addiction and being sick all the time. Get your shit straight then decide if you want to stay or come off.

I have taken it with no dependency as well and you still feel a slight something.
 
Interesting to read indeed! It's good to hear from someone with as much experience as you.

I've googled the Bernese method, and I can imagine it's a life saver for some. Personally I'm going to try the normal method first, although I'm not looking forward to going into withdrawal before taking the Bupe.

What happens if I take the Bupe before going into withdrawal? Then I go into withdrawal, but how can that be worse than being in withdrawal already? That's what I fail to understand
 
Right, that's kind of the issue.

Bupe is only a partial with a ceiling. It goes into you, takes out the current opiates from the receptor, and replaces them with bupe. And the issue with coming off a massive habit like fent / methadone. There is no way the bupe can cover that if have too many opiates in you. Its a tricky drug. So if you been on fent or methadone for like 5 years, there is no way bupe will work without some really good clean time as its only a partial. And I guess where the Bernese method comes in. I have never tried that.

As much as subs float around here, I have heard some CRAZY stories about PWD. Especially from the fent dope these days. Those guys just back out and start getting high on top and try again.

Its unlikely the doctor would dose you if he doesn't think its time. He will be using the COWS scale too. And why they start with the smallest dose and wait a bit. If you are getting better, then you can take more. If you are getting worse, then they will probably have you wait a while and try another small piece.

When I went into PWD I just took more and more. About 12 hours in I was good. I do remember eating and sleeping good that night. After being under the influence of a full agonist for so long, takes a few days to adjust to "normal". However, if you are truely in withdrawal, there is no way PWD will happen.

So another night of oxy, and tomorrow morning and you are done?
 
TheInvisibleStoner said:
But yeah, you really can't abuse that stuff. Has a ceiling. Also cannot IV the strips due to narcan.
Click to expand...

Hey man just want to point out that 1.) This is completely false, because 2.) it is actually not the nalaxone that puts you into precipitated wd, but the bupe itself. Drs or someone down the line, is lying about it. I've induced precips one time, and it was from shooting the little white ones (8mg, with a down arrow, lol - but, no narcan in these). And I've shot the strips well over a hundred times never a bad result - although disclaimer: it is not an attractive memory, looking back and thinking of that thick oj syrup getting sucked up...

Sorry I do have an on topic point though, and that is that: OP, you are on a decent handful of opiates a day... So I don't blame you (or anyone ofc) for taking the subs route. However, have you ever tried Kratom?

Yes, it tastes like shit, but fuck, it works so well! I was on a similar mg amount of morphine daily for a decade, and quit a few times successfully with only Kratom. You literally do not feel the withdrawal!

And I ask if you've tried that method, because I know a LOT of people on subs. Half sell them (to me, lol) so they can buy h or meth, and the other half regret ever getting on them. Including myself. I had a good friend coming off a nasty H habit, and I have him half of an 8mg sub to get him to feel better... He ended up way too fucking high and puking all over.

My main point - subs are WAY stronger than any opiate I've ever encountered (and I think I've shot them all, except maybe the fet analogues), and imo/e, the doctors prescribe you WAY too much, to keep you on them for life.

I know this is last minute, and sorry to possibly give you conflicting advice to what the other homie has said, so if you do go the sub route, take his advice man. 1-2mg and you honestly will be feeling fine. I GUARANTEE if you take a while 8 mg pill at once, even with your oxy habit, you'll be nodding and sleeping for a day and a half. Which is cool, but I'm assuming not what you're going there for.

Good much with whatever you do, homie <3
 
Lawrence Arms said:
Hey man just want to point out that 1.) This is completely false, because 2.) it is actually not the nalaxone that puts you into precipitated wd, but the bupe itself.
Click to expand...

What is completely false?

First of all we all know bupe itself it an antagonist. Subutex or suboxone will put you into withdrawal regardless if it cannot cover your dependency after it rips all the opiates off your receptors (the antagonist)

Now the strips (suboxone) ALSO contain narcan. This is not absorbed under the tongue. If you IV it, you are basically shooting straight narcan. This is why you will no longer find subutex around like you used to. You can IV and sniff it. But the strips can only be absorbed under your tongue, another ROA and you will be taking narcan. And why suboxone is so freely given, you cannot abuse it.

Subutex and suboxone are 2 different things. There are 2 antagonists in suboxone. Bupe itself AND narcan .

Please expand on what is false?

Better question for you. What do you think the point of putting narcan in suboxone is? For decoration?
 
TheInvisibleStoner and Lawrence arms. Thank you for replying, and sorry that I haven't responded till now! I'll be quicker to respond from now on.

TheInvisibleStoner: Thanks a lot man for your replys before I went to the clinic. They really gave me a much more clear picture of what I was going in to, which was a big relief.
Lawrence arms: Thanks a lot for your input as well. Actually I have quite a lot of Kratom in my freezer. I never actually tried it, but I bought it to help me quit the Oxy. Now I guess I'll use it to help me quit Bupe when that becomes relevant. My mission right now is to create a stable life, so the goal (short term) is not necessarily to become totally clean.

So I went to the clinic Monday, in withdrawal.
The doctor present told me to wait another 24 hours and then come back to start treatment. So I suffered through another day of wihdrawal, and treatment was started this morning.

To be honest I don't know how many mg's the nurse gave me, but he dosed 4 times, so I think I got 8mg Suboxone. Plus another 4mg to bring home. I've taken 10 in total I think, but I feel like I could easily have taken twice as much. I'm restraining myself to take my last 2mg, because I don't want to build a massive tolerance from day one.
I'm going back tomorrow morning, to get the same dose, I assume. This will happen a few days, and then I assume that they will give me for a week at a time. Hopefully even more.

Today has been okay, atleast when withdrawals ended. No physical withdrawal after last dose, but my emotions still have to get used to the lack of Oxy. So there's some sadness here and there, but that's part of recovery.
I feel grateful to live in a world where people actually care enough to want to help me with a problem that I created myself. Both you guys, and the people at the clinic. I lack words, but I'm very grateful.

The next thing I'm looking in to is how to get the most out of Suboxone. Perhaps you can be of help with that?
I've read that sublingual use only have 30% bioavailability. Maybe even less for me because I produce an absurd amount of spit, so I end up swallowing a lot of the sublingual pills.

So the routes that I'm thinking about are:
1) Letting the Suboxone pill dissolve in alcohol, soak it into cotton and placing cotton under tongue. There are posts about it here on bluelight.
2) Rectal bioavailability is 54%. So I'm considering either just putting the pill directly up my bum bum, or dissolving it and squirting it up with a syringe. I really don't like messing about back there, but if I can use half the amount of medicin with the same effect, I'm willing to make the sacrifice. As far as I can read, the bioavailability of Naxolone is 15% rectally, which concerns me a bit (compared to the 1-2% sublingual bioavailability).

So I'm very curious to hear from someone who's tried both the "Dissolve in alcohol" method, and rectal administration, and can tell which one works the best. I might make a thread about it at some point, but any inputs here would be appreciated.
 
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Yeah, subs are tricky. Never had the pills. With the strips I found the best is cutting a piece (I probably said this) and putting it right on the vein under the tongue and lock your tongue down. And then maybe take another. Huge doses for some reason seemed to work against me I supposed since so much saliva is produced and most goes down your throat. Not sure if the larger dose was wasted from this, or more of the Naxolone was absorbed this way.

I'm sure others will comment.

It takes a couple days to build up. And it does take time to adjust to "normal". You will think you are sick, but if you aren't yawning, then its just the adjustment to a partial agonist.

Had a feeling he would tell you to come back if you didn't look ready.
 
Hey
TheInvisibleStoner said:
You will think you are sick, but if you aren't yawning, then its just the adjustment to a partial agonist.

Had a feeling he would tell you to come back if you didn't look ready.
Click to expand...

Hey man, thanks again for being so quick to respond. I'm not sure understand you correctly on the first part. English is not my first language, so excuse me :) I feel slight nausea and headache on the Suboxone, but it's not a withdrawal type of sickness. And it's very mild. Almost nothing

On him telling me to come back. You think he did that because he could see on me, that the dose I was on (in this case 8mg, as I was on before I left the clinic, I think), was not a proper dose for me to land on for daily use?

I'm still very curious to hear what people think is the best route of administration, beside from IV/IM. I mean, which route has the highest bioavailability
 
I got that too (headache and nausea) when inducing from methadone. I took a lot. Ate up like 24mg in 24 hours. Once it builds up, you will see you will need less. Headache and nausea is listed as side effects, but didn't get them after I balanced out. Its a shock to your system to withdrawal, then induce onto subs. Ended up taking 2mg 2x a day for a couple weeks then stopped.

The doctor probably just saw you weren't ready. Would imagine by now he can simply look at a patient for a few minutes and tell right away. Easier to tell the patient to come back, than deal with PWD.

All doctors do it different. Having the patient come back the next day is pretty common. He probably isn't sure how much you need yet.

I would imagine the naxolone will be an issue for anything aside sublingual. This drug is designed to not be abused. Perhaps another will answer that.
 
A couple things:

TheInvisibleStoner said:
First of all we all know bupe itself it an antagonist. Subutex or suboxone will put you into withdrawal regardless if it cannot cover your dependency after it rips all the opiates off your receptors (the antagonist)
Click to expand...

Buprenorphine is a partial agonist at the mu-opioid receptor and antagonist at the kappa-receptor. It does act similar to an antagonist at the mu-opioid receptor due to it’s high affinity as it’s able to create a large mu-opioid receptor blockade, especially at high doses. It is also for this reason, it’s high affinity, that it causes precipitated withdrawals as it will displace most other opioids currently bound to the receptor.


Lawrence Arms said:
2.) it is actually not the nalaxone that puts you into precipitated wd, but the bupe itself.
Click to expand...

This is complicated. Sublingual bioavailability of naloxone is only 2 to 3%, so if taken correctly, the naloxone isn’t able to cause precipitated withdrawals and the buprenorphine itself does.

If someone were to IV buprenorphine with no other exogenous opioids bound to the mu-opioid receptor, it likely wouldn’t result in any withdrawals due to naloxone and buprenorphine having a similar affinity and there still not being a high enough amount of naloxone to displace the buprenorphine, in addition to naloxone’s short half-life compared to buprenorphine’s long half-life.

TheChoicesWeMake said:
I'm still very curious to hear what people think is the best route of administration, beside from IV/IM. I mean, which route has the highest bioavailability
Click to expand...

I can not stress this enough, buprenorphine is an extremely potent opioid. And, it’s a partial agonist, which means it’s completely useless in terms of recreational use at doses higher than 2 to 4 mg/day.

Sublingual is the perfect route of administration for Suboxone, because of the low bioavailability of naloxone, you will get some of the benefits of low-dose naloxone in terms of tolerance, and you really do not want to exceed 4mg/day unless you’re concerned about relapsing. You can actually experience as close as possible to full agonist opioid like effects around 2 mg/day. Now, with that being said, doctors are shifting more and more to prescribing extremely high doses. They are attempting to create a large blockade of your mu-opioid receptors, for the chance you relapse, it would save your life. I would have a very open and honest discussion with your prescribing doctor about this.

To give some reference,

1 mg of parenteral fentanyl is equivalent to 100 mg of morphine (MME)
1 mg of parenteral buprenorphine is equivalent to 75 mg of morphine.
1 mg of sublingual buprenorphine is equivalent to 30 mg of morphine.

When it comes to buprenorphine, less is more.
 
Thank you for your replys. Very helpful! Really.
I've been on 22mg per day, all week, and I actually feel ok on that dose.

However, I've read over and over that less is more, just like you are pointing out Deru.
So I'm going to lower my dose over some time. Today I've only taken 4mg so far, and I'll probably keep it at 8mg or so.
I would love to get my daily dose down as low as possible, so I'll be working on that.

I am still interested in different routes of administration though, because I like the idea of getting as much out of the pills as possible.
So I've been reading more about the sublingual-soaked-in-alcohol method, and rectal administration.
I can't seem to figure out which one has the highest bioavailability, so I might have to make a seperate thread about it.
So I'm still very interested in hearing peoples experiences with these ROA's.

I am incredibly grateful to have been put on Suboxone. Already now my life feels a lot more stable, and I can feel my focus slowly switching towards improving my life, rather than just coping and surviving.
It might sound silly, but it has helped me a lot, that you guys have been so helpful. It's given me a feeling that some people actually care. And my experience with the clinic has certainly added to that.

Deru, what are the benefits of low dose Naxolone in terms of tolerance? I wasn't aware that Naxolone affect tolerance. Thanks!
 
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