Bupe Is Suboxone supposed to help stave off cravings or is it just meant to keep you out of WD/keep you from getting high?

[ivorymoon]

I know that Suboxone stops PHYSICAL cravings that occur when you aren't getting enough opiates AKA withdrawal, but that's not what I'm talking about. (That's why I worded my question as "...or is it just meant to keep you out of WD...", with "WD" meaning "withdrawal", as I'm certain you already know.)

I'm talking about psychological cravings, like when you can "hear" your addiction in your head just incessantly nagging at you to get high, and using is all you can think about.

When I first started taking Suboxone, those nagging cravings completely went away for the first month but then they came back. I've been on it for 2 years and that first month was the only period of time where the subs provided relief from my cravings. Even raising my dose did nothing for them.


I've been lead to believe by doctors and fellow patients at my clinic that Suboxone and Methadone are helpful with lessening those cravings. Is that not true?

Or is it true and perhaps I'm just one of those people that Suboxone doesn't stop cravings for and I either need to suck it up, switch to Methadone, or taper down and stop Medication Assisted Addiction Treatment all together?


Thank you so much in advance.

 

[JessFR]

In my opinion, thinking of the psychological cravings as entirely separate is a mistake.

In my experience psychological cravings ARE physical cravings.

So, if you're having incessant physical cravings, it's may be that your body really does feel like it's not getting enough opioids.

What surprises me is that you're still experiencing this after 2 years. I would have thought you'd have adjusted to it by now.

All this said I've never been on subuxone. But in the several years I've been on methadone, most of the time I have not craved heroin. Sometimes yes, but not most of the time and definitely not all the time.

 

[Deru]

I've been lead to believe by doctors and fellow patients at my clinic that Suboxone and Methadone are helpful with lessening those cravings. Is that not true?

The cravings you describe are best dealt with by behavioral changes and finding healthy coping mechanisms. Buprenorphine specifically, as a partial agonist, is very poor at managing cravings and the risk to reward to increase dosage to try to compensate for it is almost never worth it and just causes more long term issues.

I got trapped in the buprenorphine cycle for 11 years so I'm well aware of what you're experiencing - I've been off of it for 3 years and I can never imagine going back on it for some of those specific reasons.

 

[ghostandthedarknes]

it's not satisfying in terms of being high. just kept me held from wd and sleepy all the time.

 

[OpiateKiller]

I have found suboxone does a mediocre job at stopping cravings. But it doesn't stop them completely for me. It all depends on where I'm at but just suboxone is not enough for me I've realized, hence why I'm switching to methadone.

 

[the_ketaman]

What needs to happen is you need to recognise why you're using and tackle all the hard stuff.
For me, bupe only slightly takes away my desire to use. The rest is willpower and support from people around me.
Methadone is worse. For a few months you feel awesome then tolerance builds and your stuck on this really crappy merry-go-round. Methadone is just incredibly hard to get off. Suboxone is a walk in the park compared me to get off.

Depending on how long you've been physically dependent on opiates and what dose, will determine your needs.
For very short term I'd say do a detox and maybe a couple of weeks on a reducing regime with Suboxone.
For medium/heavy use I suggest going on the program but if your using like grams a day or heroin you will probably require methadone maintenance at first. I almost think it's easier in every way to just use heroin to ween yourself down and off if you can manage the self control. Methadone/bupe both suck long term.
I'm only 29 and I have already suffered permanent physical changes in my body.

If you can, just detox and stay away from mmt.

 

[ivorymoon]

In my opinion, thinking of the psychological cravings as entirely separate is a mistake.

In my experience psychological cravings ARE physical cravings.

So, if you're having incessant physical cravings, it's may be that your body really does feel like it's not getting enough opioids.

What surprises me is that you're still experiencing this after 2 years. I would have thought you'd have adjusted to it by now.

All this said I've never been on subuxone. But in the several years I've been on methadone, most of the time I have not craved heroin. Sometimes yes, but not most of the time and definitely not all the time.

So it'd be safe to say that physical and psychological cravings are essentially one in the same? I know I often wake up in withdrawal which shouldn't happen considering the longass half-life of that shit.

I know you can't say for sure but would it be fairly valid to conclude that I'm simply not absorbing enough bupe?

Also, I've got a question about methadone, if you don't mind:
Have you noticed tooth decay/loss while on methadone?

I've heard the methadone itself causes one's bones to become weaker (or something along the lines of that) but I've also heard that the dental issues that occur while on methadone stem from the met causing dry mouth.
What's your take on this?

My addiction started with abusing methadone and morphine, then I "graduated" to harder drugs and was a poly-abuser but heroin was my ultimate DOC.
I would abuse methadone and morphine whenever I couldn't get my hands on heroin and I have noticed both tooth loss and tooth decay since then but it's hard to say what caused it since my dental hygiene sucked while in active addiction.

 

[ivorymoon]

The cravings you describe are best dealt with by behavioral changes and finding healthy coping mechanisms. Buprenorphine specifically, as a partial agonist, is very poor at managing cravings and the risk to reward to increase dosage to try to compensate for it is almost never worth it and just causes more long term issues.

I got trapped in the buprenorphine cycle for 11 years so I'm well aware of what you're experiencing - I've been off of it for 3 years and I can never imagine going back on it for some of those specific reasons.

Yeah, I agree with you referring to obtaining healthy coping mechanisms. It's no excuse but it's gotten a lot harder to work on that ever since this COVID shit caused my clinic to temporarily cancel groups and the ability to come in and see my therapist.

I do have the option of keeping appointments with my therapist via phone calls and FaceTime type shit, though. Maybe I should stop allowing my anxiety to keep me from setting up appts with my therapist lol I suck.

I hope you don't mind me asking but when you got off of bupe, did you switch to Methadone or are you completely free of opiates?

 

[Deru]

So it'd be safe to say that physical and psychological cravings are essentially one in the same?

When you say physical craving, do you mean the physical withdrawal opioids cause and the craving for it to go away?

If so, then they are two very, very, very different things.

A psychological craving, as described in the OP, is not about the physical need for the substance anymore and is entirely physcological.

There should be some distinction allowed, because during the acute withdrawal period there is a physical need for the drug.

 

[ivorymoon]

it's not satisfying in terms of being high. just kept me held from wd and sleepy all the time.

Since you're talking about it in past-tense, I assume you're off of bupe now, correct? I hope you don't mind me asking but did you switch to met or are you off of opiates now?

 

[Deru]

I hope you don't mind me asking but when you got off of bupe, did you switch to Methadone or are you completely free of opiates?

I'm completely free from buperenorphine for three years. I had two relapses early on, and I may very well have them again, it's part of the addicition. But I have the tools and the support system now to deal with them, when and if that need were to arise.

The biggest thing I had to learn was to deal with the root cause issues that drove my addiction and learn to make new positive behavioral changes. It was a long, long process.

As for any opiod with a half life longer than 6 hours, you couldn't pay me to put them in my body ever again.

 

[ghostandthedarknes]

Since you're talking about it in past-tense, I assume you're off of bupe now, correct? I hope you don't mind me asking but did you switch to met or are you off of opiates now?

I'm a little over a year clean of opioids. i did a rapid taper, think it was 7 days with a doctors help.

 

[JessFR]

So it'd be safe to say that physical and psychological cravings are essentially one in the same? I know I often wake up in withdrawal which shouldn't happen considering the longass half-life of that shit.

I know you can't say for sure but would it be fairly valid to conclude that I'm simply not absorbing enough bupe?

Also, I've got a question about methadone, if you don't mind:
Have you noticed tooth decay/loss while on methadone?

I've heard the methadone itself causes one's bones to become weaker (or something along the lines of that) but I've also heard that the dental issues that occur while on methadone stem from the met causing dry mouth.
What's your take on this?

My addiction started with abusing methadone and morphine, then I "graduated" to harder drugs and was a poly-abuser but heroin was my ultimate DOC.
I would abuse methadone and morphine whenever I couldn't get my hands on heroin and I have noticed both tooth loss and tooth decay since then but it's hard to say what caused it since my dental hygiene sucked while in active addiction.

I would say it would be valid to conclude that your body seems to think it needs more opioid activity than it's getting.

I've heard the "weakened bones" claim before and I'm pretty confident that it's a myth. That methadone can cause dry mouth, and that dry mouth can cause tooth decay, both of those are certainly true and you should keep an eye out for it. But that's about it. Anything beyond that I've seen no evidence for and I believe it's probably just people misunderstanding the situation.

If I were in your position I'd definitely consider switching to methadone. But I'm also keenly aware that opinion is influenced by my own biased experiences. I've had a lot of success with it. And I don't believe a non maintenance option was realistic for me. Your circumstances might vary.

 

[Deru]

I think methadone is a much better option than buprenorphine for satisfying the cravings for a full agonist. For people with heavy addictions, a lot of times methadone is the better choice. It's just a shame that here, in the US, methadone requires going to the clinic almost every day - and after you prove yourself you can get some sort of trust built up and take home medication for a short period of time.

It's just a lot more hoops to jump through for someone trying to live a normal, functioning life and very difficult, if not impossible for many people to actually integrate into their life.

 

[Playernm3]

I think methadone is a much better option than buprenorphine for satisfying the cravings for a full agonist. For people with heavy addictions, a lot of times methadone is the better choice. It's just a shame that here, in the US, methadone requires going to the clinic almost every day - and after you prove yourself you can get some sort of trust built up and take home medication for a short period of time.

It's just a lot more hoops to jump through for someone trying to live a normal, functioning life and very difficult, if not impossible for many people to actually integrate into their life.

I'm having the same issues with Bup. I have to take a massive dose to curb the cravings and doing that keeps me up for two days which then exacerbates everything and becomes a vicious cycle. I'm just terrified of methadone but my good friend swears by it. He gets it in one month supplies and he's in Oregon. Is that unheard of in the US?

 

[Rebelgal54]

Also, I've got a question about methadone, if you don't mind:
Have you noticed tooth decay/loss while on methadone?

I personally began to have a lot of problems with my teeth after starting on MMT. I had no prior dental issues but noticed a considerable change in only 9 months. It was as if the methadone stripped my teeth of all their protective enamel. Cavities would form and quickly get worse. I eventually had to have many of my molars pulled right out because I frequently got abscesses and I couldn’t afford the needed root canals.

I did some research in the past regarding methadone’s effect on oral health and this is what I found out:

Methadone can cause moderate amounts of xerostomia, or dry mouth, by decreasing saliva production. Low saliva flow can result in an increased accumulation of plaque and bacteria in the mouth, which if not treated leads to higher numbers of dental cavities and increased cases of gum disease and gingivitis.

Liquid methadone is most often a concentrated sucrose-syrup preparation, so its high sugar content also contributes to increased dental cavities. Some users will hold the sugary liquid in their mouth for a few extra minutes trying to increase sublingual absorption, others who share or sell their dose will cheek it even longer. Methadone also has a high acid content, which increases the risk of erosion. Brushing your teeth too soon after dosing can intensify the erosive effects on tooth enamel. (I was guilty of doing this a lot before learning this- I hated the taste of that nasty pink liquid in my mouth so I’d try to brush the taste out as soon as I could)


Also, the activation of opioid receptors by drugs like methadone have been shown to enhance the reward pathways generated from food ingestion. Methadone users tend to have cravings for sweets, resulting in a diet that is high in sugary foods and carbonated beverages.

Without diligent oral care and a balanced diet, many individuals on long term methadone maintenance (MMT) end up with rapid tooth destruction caused by aggressive cavities. Dentists have begun to use the term “methadone mouth” to describe the poor oral health of those on long term MMT (but this is not to be confused with the much more extreme “meth mouth” caused by Methamphetamine use).

 

[JessFR]

I personally began to have a lot of problems with my teeth after starting on MMT. I had no prior dental issues but noticed a considerable change in only 9 months. It was as if the methadone stripped my teeth of all their protective enamel. Cavities would form and quickly get worse. I eventually had to have many of my molars pulled right out because I frequently got abscesses and I couldn’t afford the needed root canals.

I did some research in the past regarding methadone’s effect on oral health and this is what I found out:

Methadone can cause moderate amounts of xerostomia, or dry mouth, by decreasing saliva production. Low saliva flow can result in an increased accumulation of plaque and bacteria in the mouth, which if not treated leads to higher numbers of dental cavities and increased cases of gum disease and gingivitis.

Liquid methadone is most often a concentrated sucrose-syrup preparation, so its high sugar content also contributes to increased dental cavities. Some users will hold the sugary liquid in their mouth for a few extra minutes trying to increase sublingual absorption, others who share or sell their dose will cheek it even longer. Methadone also has a high acid content, which increases the risk of erosion. Brushing your teeth too soon after dosing can intensify the erosive effects on tooth enamel. (I was guilty of doing this a lot before learning this- I hated the taste of that nasty pink liquid in my mouth so I’d try to brush the taste out as soon as I could)


Also, the activation of opioid receptors by drugs like methadone have been shown to enhance the reward pathways generated from food ingestion. Methadone users tend to have cravings for sweets, resulting in a diet that is high in sugary foods and carbonated beverages.

Without diligent oral care and a balanced diet, many individuals on long term methadone maintenance (MMT) end up with rapid tooth destruction caused by aggressive cavities. Dentists have begun to use the term “methadone mouth” to describe the poor oral health of those on long term MMT (but this is not to be confused with the much more extreme “meth mouth” caused by Methamphetamine use).

Just a little add on to this. Most methadone syrup preparations I'm aware of no longer contain sugar for this exact reason. If they contain any sweetener it's probably glycerin. Though obviously this will depend on the brand you've given. I know it's the case with both of Australia's methadone syrup brands though.

It's also my understanding that most clinics have stopped providing any kind of sweet substances to dilute methadone for the same reason.

I've heard from people older than I am that methadone in Australia used to be diluted with cordial for instance. But that's well before my time and I've only seen ordinary water given with it. So I'd say things have probably improved a lot over time.

But there's no getting around the fact that opioids tend to cause dry mouth, and methadone seems especially prone to causing that side effect.

Personally, even putting aside any denial reasons. Id much prefer they didn't screw with the taste at all. Straight bitter methadone taste isn't exactly pleasant, but it's way better IMO than trying to disguise it.

 

[DeathIndustrial88]

I'm having this same issue with bupe. Been on it for 4 years. In the beginning it was great. Gave me a lot of the same positives I get from heroin and other full agonists, but I never had to worry about withdrawals. Now all it does is make me really drowsy at the wrong times, if it does anything at all. It has kept me from going back to alcohol at least.

I'm one of those people that knows and has accepted that I'm going to need opiates forever because I'm an addict and I enjoy them. They keep my depression more at bay than any other drug on the planet, next to cannabis.

I find if you keep your doses very very low, bupe will help you out much more. Keep it low and then one day raise it a bit and you can get some of the magic back temporarily. The rest is willpower.

It sucks that the US is still so in the dark ages when it comes to drugs and drug addiction. Many places in Europe offer actual heroin maintenance, along with extended release morphine, hydromorphone, extended release tramadol, etc.. But here we are stuck with bupe and methadone and methadone is out of the question unless you literally live right next door to a clinic. It's bogus.