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Bupe Overdosing on Opiates While on Suboxone

Harley3311

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Oct 29, 2009
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I believe Tom Petty wrote a little song about it..
Is it harder or the same to overdose on Suboxone? For instance I've never took more than about 120mg of oxycodone in one sitting (up zee nose). Though If Im on about 4mg of Suboxone steadily and I have a high tolerance to that, would it be harder to OD on Oxycodone due to the fact that I am I suboxone or would that not make a difference to the toxicity of Oxycodone? Thanks cheers!;)
 

pstyles89

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Apr 16, 2006
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I dont think you can overdose on suboxone alone since it has a ceiling effect at 32 mg, but someone correct me if im wrong please.

Taking other opiates with suboxone, however, can be very dangerous since you may not feel the effects of the other opiate(due to bupes affinity for opioid receptors) and keep dosing. Continued dosing=overdose.

There is probably some more info on this in the bupe megathread, check it out
 

Mr Blonde

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I can't remember, but you can overdose. I think dosing opioids whilst on subs can produce the negative effects (CNS depression, etc...) whilst no euphoria. But the negative effects are less pronounced.
 

Captain.Heroin

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RIP CH ? - 2020
It's easier to overdose on a partial agonist.

You can still overdose while on Suboxone, because Suboxone doesn't have to take up 100% of your receptors, unless you're on a huge dose.

If you're on buprenorphine, it's probably easier to overdose, unless you're on a large dose. It's better to only use Suboxone, or full agonists, and not to combine them IMO.

Keep in mind people don't do studies on how "easy" it is to overdose, overdosing is something that should be avoided as a rule of thumb.
 

sixpartseven

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It's easier to overdose on a partial agonist.

You can still overdose while on Suboxone, because Suboxone doesn't have to take up 100% of your receptors, unless you're on a huge dose.

If you're on buprenorphine, it's probably easier to overdose, unless you're on a large dose. It's better to only use Suboxone, or full agonists, and not to combine them IMO.

Keep in mind people don't do studies on how "easy" it is to overdose, overdosing is something that should be avoided as a rule of thumb.
How do you figure that it's easier overdose on a partial agonist? Drugs like buprenorphine are very difficult to overdose on because there is barely any CNS or respiratory depression. Tolerance plays a huge role, though. Someone with a low tolerance will have an easier time ODing on Buprenorphine than someone with a tolerance.

As for overdosing on a full agonist while on Suboxone: theoretically, it would be harder to OD because the buprenorphine saturates the receptors and doesn't allow the oxycodone to bind. It's still possible to overdose, but it will take a larger dose than it normally would have.

For example, if you need 40mg of opiate-x to get high, and 60mg to overdose on opiate-x, while on Suboxone, you'll need more like 60mg to get high, while needing more like 80mg to overdose.

Since buprenorphine is stopping the other opiate from binding, there isn't much danger in the two working together to make overdose more likely. Even though you took a full agonist along with the buprenorphine, the buprenorphine is really the only drug that is active, unless you took a massive dose of the agonist to "break through" the buprenorphine.

So, in effect, Suboxone raises the overdose threshold, but be careful because there is no way to know exactly how high the threshold has been raised. It varies from dose to dose and person to person, so if you've recently taken Buprenorphine and want to get high on another opiate, it's best to start with the dose you are comfortable with and work your way up as needed.
 

onmyway

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Sep 11, 2009
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you must mean that its easier to overdose in spite of a partial agonist rather than in spite of an antagonist.

either way, it would depend on your tolerance. a person with low tolerance could end up getting in trouble here...
 

morphinanymous

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I feel its easier to od on suboxone because when I break down and start turning bitch and have to take something for my S shaped (yes literally its in the shape of an S) back I have shot 32+mg of hydromorphone 30 hours after 32mg dose of suboxone it made me feel extremely sedated but not high and almost not in a "i'm on a nod" sedation either. This also happened another time IVing another substance after taking a large dose of suboxone. It could have been the large dose coulda been the mix, just another one of Suboxone (Bupes) great fantastic mysteries.

I just say wait and if you're scared of od'ing then don't OD man just split it in half. I just say NO you will not od on 120mg of OC if your on 4mg of Subs, if those are high tolerances to you then you don't have much of a tolerance in the first place and the subs will probably block it anyways. I don't understand waiting, a day at least, to try and use again, I have gone through excruciating pain and waited 36 hours to use again after subs, but that is particularly with IV drugs.

Its like the cool thing to call the people with subs at 10am on Sunday morning begging for them where I am from "ohhhh I hurt so bad" and then around 5pm yo man.....etc."

Stop wasting drugs(not saying I haven't experimented") when they won't get you high on Suboxone. Snorting won't cut through shit if you ask me.
 

Tchort

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Overdoses on Buprenorphine are possible, and appear in the literature (especially in combination with a CNS depressant- Benzo's + Buprenex/Subutex/Suboxone has caused a lot of deaths wordwide).

Overdose of Buprenorphine is most likely possible, in other parts of the world (Central Asia, South Asia, Eastern Europe, etc) IV Buprenorphine is the most common way to use it, often in combination with IV Benzodiazepines.

I'd imagine too much Bupe IV in a naive user would result in a typical opioid OD.

Naloxone infusion and another drug that is not a mu-antagonist that is a respiratory stimulant (name escapes me) are recommended in the literature for Buprenorphine OD.
 

Pegasus

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As for overdosing on a full agonist while on Suboxone: theoretically, it would be harder to OD because the buprenorphine saturates the receptors and doesn't allow the oxycodone to bind. It's still possible to overdose, but it will take a larger dose than it normally would have.
I think that was his point, that when someone has bupe in their system and is trying to get high, they will use larger doses than normal, leading to more respiratory depression than normal from similar effects from the oxycodone...
 

daddysgone

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I think that was his point, that when someone has bupe in their system and is trying to get high, they will use larger doses than normal, leading to more respiratory depression than normal from similar effects from the oxycodone...
Ok, but lets try to make all of this a bit clearer.
Lets just assume that under normal circumstances (no bupe in your system), 200mg of oxy for instance, would be a borderline overdose for you.
Is the consensus that if one had bupe in their system and then took 200mg of oxy, they would be less likely to experience an overdose then if they had just taken the oxy on its own?

I am interested regarding whether or not at low doses of bupe, it might be possible that the combo of bupe and oxy might make it MORE likely for one to experience an overdose. Is it possible that at low doses when your opiate receptors are not saturated by bupe, if one were to then take a full agonist (like oxy), there might actually be an additive effect from the bupe and oxy, which would consequently make an overdose more likely?


I guess an even easier way of asking all of this is:
"While on bupe (at any dose), would it ever be necessary to actually lower your normal dose of a full agonist in order to avoid an overdose...or will you always need to take an equal or higher dose of the full agonist while on bupe?-DG
 

Pegasus

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^I think that both ends of the spectrum apply. A lower dose of bupe will synergize, making the 200mg oxy stronger. On the other end of the spectrum, people on a dose of bupe sufficient to block the majority of other opiates and trying to break through the blockade with a high dose of opiates risk respiratory depression because they are actually more depressed than they would think they are given the effects that they are feeling. This is my understanding of this...
 

sixpartseven

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I don't see how Buprenorphine is going to synergize with other opiates. I may be missing something, but buprenorphine has almost no CNS depression, very limited respiratory depression, and if you have any sort of tolerance to opiates, it's not going to get you "high." In this case, if you take another opiate, all it does is block that opiate, no? What about it would synergize? Not to mention, if bupe is blocking the Oxy from becoming active, how is inactive Oxy able to synergize with Bupe?

In my mind, if you took 200mg of Oxy without Bupe and that was your OD threshold and you had a mild OD, that same 200mg with Bupe would not cause an OD because the Bupe is blocking a majority of the Oxy from becoming active. So again, if the Oxy isn't active, how is it able to synergize with the Bupe? If the Oxy isn't active, how could it cause an OD?

I'm not being a smart ass, I'm seriously wanting to know because I think I might not be understanding what you guys are saying. It just doesn't make sense to me how the two could work together to cause an OD when one is preventing the other from being activated.
 

BaybeX

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Wow.. look at all the mods.

This should be added to the OD Directory, IMO..
Lots of good information in here.. and I'm sure I'm not the only one that was also curious about this!
 

Cane2theLeft

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I'm not being a smart ass, I'm seriously wanting to know because I think I might not be understanding what you guys are saying. It just doesn't make sense to me how the two could work together to cause an OD when one is preventing the other from being activated.
I've wondered the same thing... djsim and others have spoke of the immense danger in trying to break through partial agonists with full agonists but I still don't see it as being MORE dangerous.

I would think that the bupe would block a substantial amount of the oxy making OD less likely as you said.

Every drug has a therapeutic index which is determined by dividing the LD50 by the ED50 (lethal dose in half the population / effective dose in half the population). I have never heard a convincing argument saying that opioid doses that break through partial agonists would have a lower therapeutic index... of course you would need a higher mg dose to break through, but I would assume the window between desired effect and OD would be the same ratio with or without bupe unless people have evidence to the contrary.

great thread, btw... obviously a topic that could use more clarification and has obvious HR value.
 

sixpartseven

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Wow.. look at all the mods.

This should be added to the OD Directory, IMO..
Lots of good information in here.. and I'm sure I'm not the only one that was also curious about this!
I agree. I will add it shortly.

Thanks for the suggestion.

I've wondered the same thing... djsim and others have spoke of the immense danger in trying to break through partial agonists with full agonists but I still don't see it as being MORE dangerous.

I would think that the bupe would block a substantial amount of the oxy making OD less likely as you said.

Every drug has a therapeutic index which is determined by dividing the LD50 by the ED50 (lethal dose in half the population / effective dose in half the population). I have never heard a convincing argument saying that opioid doses that break through partial agonists would have a lower therapeutic index... of course you would need a higher mg dose to break through, but I would assume the window between desired effect and OD would be the same ratio with or without bupe unless people have evidence to the contrary.

great thread, btw... obviously a topic that could use more clarification and has obvious HR value.
My thoughts too, but explained more eloquently than I was able to.

It simply doesn't make sense to me that Buprenorphine will increase the chance of an OD when it is preventing the agonist from binding. Even the small amount that would bind when taking a larger dose, it seems to me it wouldn't be anymore likely to cause an OD because of Buprenorphines limited likelihood if causing an OD on it's own. Like I said, it has very little (if any) CNS depression or respiratory depression - the two causes of an OD. Without that, how would an OD occur? In combination with a full agonist, how would that increase the depression?

(NOTE: opiate-naive users with little-to-no tolerance are more likely to OD on Buprenorphine, but if you have any sort of real tolerance, the risk of OD is incredibly slim, especially since Buprenorphine has a ceiling dose. Everything I have been saying has been in reference to people with a tolerance.)

In no way am I saying this is safe and to run out and start taking large doses of heroin because you're on Suboxone. I may be completely wrong about what I'm saying which is why I'm not presenting it as fact. Even as a Moderator you learn new things (we're just as human as the rest of you guys)...if it turns out I'm wrong, this is just another nugget of knowledge I will have obtained as a Moderator.

This is most definitely a topic that deserves a lot of attention from us. This has huge potential in contributing to the HR mission of our forum, which is why I DO NOT want anyone taking what is being said (especially what cane and I have said) as being fact just yet because of the potential dangers that could arise should we be wrong. Wait till we get some solid proof one way or another, but in the mean time, enjoy the discussion and please contribute your thoughts. This type of discussion is what we love to have in OD.
 
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TMoney11111

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Nov 29, 2005
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Ok, for anyone who does not know this, suboxone blocks the high or the sought after effects of opiates, but does not block their effect on the body. Because of this, taking any opiate while on suboxone does have an increased risk of overdose because you are combineing two different drugs that have an effect on the cns and respiratory system in larger doses. Its like alcohol and benzos, or alc and hypnotics for example. If you are just useing sub alone, overdose is not as risky compared to the average opiate because of reasons stated above. I have been on sub for over a year at one point, and I was a pharm tech and studied pharms as a hobby, and I recall when they first put me on sub in rehab two years ago, them telling me to not take any opiate, benzo, or alcohol while on it because of increased chance of overdose. You can't feel it, but you can overdose without getting high so to speak when taking an opiate on suboxone.
 
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