Opioids Precipitated withdrawal at the suboxone clinic/doctors

[Thatgirl299]

What happens or what's the protocol if you go into precipitated withdrawal during induction at the doctors office ? Do they stop inducting? Hospital ? Make you call for a ride (I cannot, my husband would leave me, no friends new in town)
It will only be 29 or so hours since last fentanyl use- I tapered down to .5 over last 2 days from a 1gm day habit. I always go into precipitated withdrawal unless it's been 36-48 hours. I did manage to ge .6mg of sub in my system (.2 day 1 --.2 day 2 --.6 day 3)
Thank you

 

[Jekyl Anhydride]

Usually a Naloxone challenge is performed after a COWS or clinical Opioid Withdrawal Scale. The idea being if you are half dead in rough WD's then induction will go fine. In many patients things go fine and after 45mins to an hour you are allowed to go home and rest up.

Not that there aren't some stories about sub docs continually administering Subs up to around the 12-16mg mark when PWD's do occur. This is usually how they are trained because these clinics don't stock CII substances to bring you out if PWD happens. There mentality is to push through it until the PWD goes away, basically you in the bathroom on the toilet with a trash can to puke into for 3 hours.

A newer type of practice is showing promise in those who've had the hardest time inducting as they were on high dose Methadone that has a notoriously long half life making the "standard" approach fraught with problems. However inducting with small doses like .25-.50mg every 90 mins can make the expulsion of the full agonist opioids and replacement with Subs go much smoother and has better success ratios,

For the people with the absolute hardest inductions there's the Bernese Method which is still considered experimental and the mainstream clinics won't touch it because it involves using small amounts of illegal opioids mixed with subs over a moderate period where the transition is very slow and the violent replacement of one substance is instead carried out over a few days lowering the chance of PWD's to almost none.

These are the methods you should speak with your Doctor about. Also inquire if you can induct with Subutex vs Suboxone, some think it helps.

The Bernese Method-for the most difficult/ multiple failed cases: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959756/

Other references while you await more responses:

Buprenorphine-naloxone treatment responses differ between young adults with heroin and prescription opioid use disorders - PubMed

These data suggest that young heroin users might require higher doses of buprenorphine. (Am J Addict 2017;26:838-844).

www.ncbi.nlm.nih.gov

Buprenorphine: how to use it right - PubMed

The unique pharmacology of buprenorphine at the mu-opioid receptor (i.e. high affinity, low intrinsic activity and slow dissociation) results in buprenorphine having: (1) a good safety profile, (2) low physical dependence, and (3) flexibility in dose scheduling. Early studies assessed the...

www.ncbi.nlm.nih.gov

Sublingual buprenorphine/naloxone precipitated withdrawal in subjects maintained on 100mg of daily methadone - PubMed

There is considerable between subject variability in sensitivity to buprenorphine's antagonist effects. Low, repeated doses of buprenorphine/naloxone (e.g., 2mg/0.5mg) may be an effective mechanism for safely dosing this medication in persons with higher levels of physical dependence.

www.ncbi.nlm.nih.gov

Bupe - Suboxone/Buprenorphine Mega Thread and FAQ v15.0

Thread Version 1.0 Thread Version 2.0 Thread Version 3.0 Thread Version 4.0 Thread Version 5.0 Thread Version 6.0 Thread Version 7.0 Thread Version 8.0 Thread Version 9.0 Thread Version 10.0 Thread Version 11.0 Thread Version 12.0 Thread Version 13.0 Thread Version 14.0 What: Suboxone =...

www.bluelight.org

 

[Ready2LiveAgain]

So when using the bernese method, is the idea to still be on a low dose of heroin/methadone/fentanyl while starting to take very small doses of suboxone (.02 mg)? While at the same time while slowly increasing the suboxone while simultaneously lowering the use of the heroin/methadone/fentanyl?

 

[KS78]

It happened to me in Cyprus when they started me with Buperenorphine after 15 hours of my last H use.
They just kept on giving more till it was over which took around 24 hours. They gave me IM Diazepam to help a little (but they said that they were giving Novalgin, an NSAID).