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Suboxone/Buprenorphine Mega Thread and FAQ V. 2.0

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sixpartseven

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The original thread by phrozen had reached its limit of 1000 posts. Thanks to phrozen for writing this. Its been a huge asset to OD. The original thread with all its posts can be found in the OD archive.

phrozen said:
What: Suboxone = buprenorphine/naloxone. Bupe is a partial agonist(mu) and antagonist(kappa). Bupe has higher mu affinity that most opiates, including some antagonists(naloxone, naltrexone). Its higher affinity allows you to shoot suboxone tablets. It also may cause precipitated withdrawals if you are dependant on other opiates. Also, its higher affinity blocks the affects of other opiates when taken in conjunction with bupe.

Dose: Depends on tolerance. 1-2mgs is a typical recreational dose for someone with no tolerance. If you're using bupe to taper off of another opiate, you should dose once you're experiencing wd's(typically 36-48 hrs. for most opiates). Start with 2-4mgs and dose at 2mg increments every 30-45minutes until a dose holds you. Most people take their full dose once a day.

Withdrawal: Typical physical and psychological symptoms associated with opiate withdrawal. Insomnia, chills, diarrhea, depression, anxiety, lacrimation, sweating, increased heart rate, etc. They are not as strong as a full agonist's symptoms, but may last longer. Physical symptoms last 1-2 weeks on average and psychological symptoms may last months.

As most opiates, it's recommended to taper down to the lowest dose possible before stopping. <1mg is ideal. The best way to dose at that level is to crush up a tablet and divide the powder into lower doses.

Ceiling: 24-32mgs

Bioavailability:


Other Notes:


Images:

Subutex


Suboxone

I couldn't find photos of Tamgesic, and Buprenex just comes in vials

Locate a doctor that prescribes Suboxone.
 
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sixpartseven

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FAQ written by phrozen

phrozen said:
Q: How long after my last bupe dose can I take an opiate and feel its effects?
A: It depends on what dose of bupe you were taking and how long. The short answer is 36-48 hours. Caution should be used when dosing, as you will still have a tolerance but it will not be as high as it was when you first got on bupe.

Q: Is bupe a good replacement for methadone?
A: Maybe. Some people with a high enough opiate tolerance may not be held by bupe at any level, even at the highest(ceiling) possible dose. You should research both before deciding what to go on, as they both have different positives and negatives in regards to their use.

Q: I'm thinking about switching from methadone to bupe. At what methadone dose should I be when I switch?
A: Most places recommend being at 30-40mgs of methadone when switching. That may be hard to achieve since that level is lower than the recommended therapeutic maintenance level. Also, you'd have to wait 36-48 hours before your last methadone dose to switch in order to avoid precipitated withdrawal

Q: Will I still have cravings on bupe?
A: Maybe. Some people report no cravings, while others report the same level as before.

Q: Is bupe good for depression/anxiety?
A: Yes, it may help with depression and anxiety. It is not currently prescribed for either and its effectiveness has not been studied for long term use for either. You may be able to get it prescribed off label for depression/anxiety, but its not likely to happen. Here is an article on PubMed about a study on bupe being used to treat depression.

Q: Is it safe to shoot Suboxone/Subutex?
A: No. It can cause many of the same complications as shooting other pills. Just because Suboxone/Subutex dissolves easily, unlike other pills, does not mean it's any safer to to shoot. The best advice is to use a micron filter. This* is a good indication of what can happen. (Although that could happen from injecting any other drug/pill.)

Q: Is bupe recreational?
A: Yes. Although it is rarely the preferred opiate for people who have experience with full mu agonists.

Q: Can you overdose on buprenorphine?
A: Yes you can. Buprenorphine causes respiratory depression which may lead to death. The person most likely to OD on bupe has a low(if any) tolerance to opiates and may have taken another depressant. A buprenorphine overdose may not be reversed by naloxone(or naltrexone for that matter) due to bupe's higher affinity. Diprenorphine may reverse the overdose, but it is not regularly stocked by emergency personnel or hospitals. If a proper antagonist isn't available, the person suffering an overdose may be maintained with assisted respiration.

Q: Can I still get high on other opiates if I'm on bupe?
A: This depends on what dose of bupe you're on. You will most likely be able to shoot through a low dose of bupe(1-2mgs). But, don't expect the full effects of the opiate you're shooting through with. Even at higher doses, if you take enough of the opiate you may feel it. This is not recommended, as you may overdose before reaching the desired recreational effects.

*Link to article provided by hfrs in a different thread
 

sixpartseven

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There has been some confusion with information regarding suboxone/buprenorphine because some are using the drug for different purposes. Most of the information provided pertains to using suboxone/buprenorphine as a maintenance aid for opiate dependency. This information sometimes goes against the suggested information for using suboxone/burprenorphine as a recreational drug.

This time around, Im going to add a quick FAQ to help users of this drug figure out what is what. The OD guidelines say we will not help anyone abuse maintenance programs, but I think its important to answer a few basic questions about recreational suboxone/buprenorphine in an effort to reduce harm when, inevitably, someone decides to use it recreationally. For example, a recreational dose is going to be significantly smaller than a maintenance dose. I think its important to make that clear.

So, here it is. The quick "Recreational Basics of Suboxone/Buprenorphine FAQ."


Can Suboxone or Buprenorphine be used recreationally?

Yes, it can, but not for everyone. One thing you must consider to figure out if you can use this drug recreationally is your tolerance. Someone who is addicted to opiates or has a very high tolerance to them will not be able to get high off of this drug. Typically, the only people who do get high from it are people who are relatively inexperienced with opiates.

If you are using suboxone or buprenorphine as a maintenance tool, you are not going to be able to get high from it, so its best not to even try. You'll run through your supply faster than normal with no beneficial gain.

How much do I need to take to get high from it?

This is an important thing to pay attention to. If you have read about subxoone/buprenorphine at all on Bluelight, you have probably noticed people taking about doses of 4mg or 6mg, or 8mg or 12mg, and sometimes even as high as 24mg or 32mg.

That is WAY too much for a recreational dose.

For someone who has little to no tolerance for opiates, a dose of 1mg or 2mg is more than enough.

What is the risk for ODing?

Even though suboxone/buprenorphine has less effect on the respiratory system, and has much less CNS depression compared to other opiates, the chance of OD is still there. This is why its important to start at as low of a dose as possible (1mg - 2mg). Because of buprenorphines high affinity to the opiate receptors, typical antagonists used to reverse OD's (naloxone and naltrexone) can not be used. There are antagonists that can reverse the OD, but hospitals wont know they are needed unless they are made aware that your OD has been caused by buprenorphine, and its going to be hard to make them aware when your unconscious, so be careful.
 

sweet jimmy brown

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i was taking suboxone 4-5 days of the week when i was low on funds to fill in the gaps between bundles. After the third or fourth weekof this Ibegan falling into terrible depressions for the majority of the day after taking my daily dose of 2mg x2/day. I am prone to terrible, crippling depressions and it seems that theybegan to cooincide with my sub dosing. If a particularly troubling event would happen (for instance my mom had cancer- she just passed away yester day- so if i witnessed her in pain the depression would go apeshit into thoughts o self harm andf suicide. Upon stopping the sub and just using small amounts of heroin/oxy/hydromorph to maintain the extreme side of this went away and I wasjust simply normal manic depressiveguy.
 

Subreflex

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I've heard St.johns wort is particularly effective at potentiating bupe, is this true? If so what type of dosage ratio of both should be taken.
 

johanneschimpo

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Mr Blonde

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Originally posted by ScurvaJunt and then merged into BA mega thread, but I figured this may interest some who frequent this thread as well:

Karsten Lindhardt, Morten Bagger, Kasper Huus Andreasen and Erik BechgaardCorresponding Author Contact Information, E-mail The Corresponding Author
Department of Pharmaceutics, The Royal Danish School of Pharmacy, Universitetsparken 2, DK-2100 Copenhagen Ø, Denmark

Received 4 October 2000;
revised 18 January 2001;
accepted 24 January 2001
Available online 30 March 2001.

Purchase the full-text article



References and further reading may be available for this article. To view references and further reading you must purchase this article.

Abstract

The purpose of the present study of buprenorphine is to add information about the correlation between various animal models and nasal bioavailabilities in man. PEG 300 was added to one formulation to study whether the addition of the co-solvent results in the same absorption pattern as seen for sheep. The bioavailability of intranasal buprenorphine 0.6 mg in PEG 300 and 5% dextrose was assessed in a cross-over study in six rabbits. The mean bioavailabilities, Tmax and Cmax were 46% (S.D. ±13) and 53% (S.D. ±17), 8 and 12 min, 28 and 27 ng/ml for 30% PEG 300 and 5% dextrose, respectively. No significant differences were found between the nasal buprenorphine formulations. The bioavailabilities in rabbit and sheep, respectively, were ≈2.5 and four times higher than for man. The absorption rate was faster for rabbit and sheep than for man. It appears that rabbit and sheep bioavailability differ from humans, especially with respect to rate. PEG 300 do not increase the bioavailability of buprenorphine.
 

N0cturnal

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Suboxone and diphenhydramine (Benadryl)?

I read the post in the Other Drugs Directory about shooting Suboxone with diphenhydramine, I have no desire to inject it but I was wondering if diphenhydramine will still increase the effects of Suboxone regardless of method of administration.

I've been on Sub for about 5 months and currently take 24 milligrams a day. When I first started taking it, 2 milligrams would give me a mild euphoria, now I have to use 32 milligrams at a time to get the same effect :\.

I'd like to try it with some diphenhydramine just for the hell of it, I'm not expecting much but I do have a bunch of extra pills and I'm bored out of my mind :) . What would be a good starting dose of diphenhydramine? 75 mgs? 100 mgs?
 

johanneschimpo

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If you dn't take diphenhydramine often, and have no tolerance, I'd say 50mg right before your suboxone does, then 25-50mg more as needed. I wouldn't go above 100mg in a 4-6 hour period if you don't take it often, as it can feel kind of weird.
It should take away the itch, and add to the nod/drowsiness a bit. Good luck.
 

N0cturnal

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Ok, I took 50 milligrams of diphenhydramine, and about 10 minutes later plugged 32 mgs of Suboxone using a 10 ml syringe, four 8 mg pills dissolved in 40 ml of warm water, I know its not the most attractive method of administration, but very effective nonetheless. I used to snort Suboxone but trying to snort 32 mgs is well ... a lot of powder, too much, and I think plugging it (on an empty colon) is stronger by a good bit.

About 30 minutes later I took another 25 mgs of diphenhydramine, I actually feel some euphoria from Suboxone for the first time in a while, I never thought that an over the counter sleep aid would have any potential.

I learn something new and interesting on a regular basis here. :)

Thanks for the advice johanneschimpo.
 
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njevad

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Ok, here is something that is totally puzzling me.

A little background info..
I have been using heroin daily roughly for a year and a half now, a year with IV use. At one point I was using roughly 15-20 bags of NJ heroin daily so it's safe to say I had a hell of a habit. Lately I've cut it down to using about 6 bags a day.

I saw a doctor and was prescribed suboxone 3x a day(24mg). I mainly saw this doctor because of family/ legal issues but I personally was not ready to drop the dope completely at that point in time so I had been using it mainly as a substitute for those days when the money wasn't there.

Anyway, after somewhat of an intervention with the police, I had decided I was going to try to give up the dope. My last dose of H was this past Saturday at about 7pm. I then dosed 1 8mg suboxone tablet sublingually at about 9pm Sunday night.(26 hours later) Since then I have not used heroin or re-dosed suboxone with no signs of withdrawal or discomfort. I actually feel fine.

Is it safe to say I kicked the habit? It's now Wednesday and I have yet to re-dose sub(62 hours) or heroin(88 hours) since. Why am I not feeling any discomfort? By this time the bupe should most definitely be out of my system. Is there any logical explanation? Why are some people on it for months or years at a time and I have had success(somewhat) with one 8mg dose?

Thanks for any replies in advance.
 

DudeImnotDAVE

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Six, can you add that Withdrawl chart I had posted in the other thread? (COWS chart)

It would help alot of people who are dosing WAY too early aviod precipitated wds.
 

DudeImnotDAVE

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Clinical Opiate Withdrawl Score- you want 25 or more

For each item, write in the number that best describes the patient’s signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient was jogging just prior to assessment, the increase pulse rate would not add to the score.

[Mod Note: Its pretty self explanatory, but obviously this test is usually administered by a doctor. I think most of us know ourselves well enough to be able to do this on our own, just make sure that you arent over exaggerating the symptoms. I know in a doctor environment, its kind of second nature to exaggerate the severity of the symptoms, but when you are doing it on your own, who do you need to fool? No one. The reason I say this is because if you do exaggerate the severity of the symptoms, you could come up with a result that may or may not cause you to dose too early, which in effect, makes taking this whole exam pointless. - 6/7]



Patient’s Name:___________________________ Date: ______________
Buprenorphine induction:

Enter scores at time zero, 30min after first dose, 2 h after first dose, etc.

Times: ______ ______ ______ ______

Resting Pulse Rate: (record beats per minute)
Measured after patient is sitting or lying for one minute


- 0 pulse rate 80 or below
- 1 pulse rate 81-100
- 2 pulse rate 101-120
- 4 pulse rate greater than 120

Sweating: over past ½ hour not accounted for by room temperature or patient activity.

- 0 no report of chills or flushing
- 1 subjective report of chills or flushing
- 2 flushed or observable moistness on face
- 3 beads of sweat on brow or face
- 4 sweat streaming off face

Restlessness Observation during assessment

- 0 able to sit still
- 1 reports difficulty sitting still, but is able to do so
- 3 frequent shifting or extraneous movements of legs/arms
- 5 Unable to sit still for more than a few seconds

Pupil size

- 0 pupils pinned or normal size for room light
- 1 pupils possibly larger than normal for room light
- 2 pupils moderately dilated
- 5 pupils so dilated that only the rim of the iris is visible

Bone or Joint aches.
If patient was having pain previously, only the additional component attributed to opiates withdrawal is scored.

- 0 not present
- 1 mild diffuse discomfort
- 2 patient reports severe diffuse aching of joints/ muscles
- 4 patient is rubbing joints or muscles and is unable to sit still because of discomfort

Runny nose or tearing Not accounted for by cold symptoms or allergies

- 0 not present
- 1 nasal stuffiness or unusually moist eyes
- 2 nose running or tearing
- 4 nose constantly running or tears streaming down cheeks

GI Upset: over last ½ hour

- 0 no GI symptoms
- 1 stomach cramps
- 2 nausea or loose stool
- 3 vomiting or diarrhea
- 5 Multiple episodes of diarrhea or vomiting

Tremor observation of outstretched hands

0 No tremor
- 1 tremor can be felt, but not observed
- 2 slight tremor observable
- 4 gross tremor or muscle twitching

Yawning Observation during assessment

- 0 no yawning
- 1 yawning once or twice during assessment
- 2 yawning three or more times during assessment
- 4 yawning several times/minute

Anxiety or Irritability

- 0 none
- 1 patient reports increasing irritability or anxiousness
- 2 patient obviously irritable anxious
- 4 patient so irritable or anxious that participation in the assessment is difficult

Gooseflesh skin

- 0 skin is smooth
- 3 piloerrection of skin can be felt or hairs standing up on arms
- 5 prominent piloerrection



Total scores

Score:

5-12 = mild;

13-24 = moderate;

25-36
= moderately severe;

more than 36 = severe withdrawal
 
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sixpartseven

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njevad said:
Ok, here is something that is totally puzzling me.

A little background info..
I have been using heroin daily roughly for a year and a half now, a year with IV use. At one point I was using roughly 15-20 bags of NJ heroin daily so it's safe to say I had a hell of a habit. Lately I've cut it down to using about 6 bags a day.

I saw a doctor and was prescribed suboxone 3x a day(24mg). I mainly saw this doctor because of family/ legal issues but I personally was not ready to drop the dope completely at that point in time so I had been using it mainly as a substitute for those days when the money wasn't there.

Anyway, after somewhat of an intervention with the police, I had decided I was going to try to give up the dope. My last dose of H was this past Saturday at about 7pm. I then dosed 1 8mg suboxone tablet sublingually at about 9pm Sunday night.(26 hours later) Since then I have not used heroin or re-dosed suboxone with no signs of withdrawal or discomfort. I actually feel fine.

Is it safe to say I kicked the habit? It's now Wednesday and I have yet to re-dose sub(62 hours) or heroin(88 hours) since. Why am I not feeling any discomfort? By this time the bupe should most definitely be out of my system. Is there any logical explanation? Why are some people on it for months or years at a time and I have had success(somewhat) with one 8mg dose?

Thanks for any replies in advance.
No, its not safe to say you kicked the habit. That is going to take a long time. As long as you stick with a steady dose of suboxone and DO NOT use any heroin, you could eventually taper your suboxone dose down and jump off. THEN you will have kicked a heroin habit, but that does not mean youre safe. You have to change your lifestyle to stay clean. Its a life-long process.

Youre not feeling any discomfort because the whole point of suboxone is to keep you from feeling any discomfort. The only reason suboxone would cause discomfort is if you took it way too early, but in your case, you took it at the right time (at least 24 hours after your last heroin dose.)

There is a logical explanation for why some people stay on it longer than others. Some people can adjust to the new life of being sober and abstaining from drugs. Others arent so good at that (like me.) There is no standard time for how long you should stay on suboxone, so dont worry about how long or how short someone else was on it. Do what is good for YOU. Stay on as long as you find it necessary. Ive been on for 15 months, and I dont think Ill be getting off anytime soon. There is nothing wrong with that, its just that if I were to get off sooner than now, I would have probably relapsed. That isnt a problem for other people. They are more confident in their ability to stay sober.

Like I said before though, you have not had success with ONE tablet. Its impossible. As soon as that suboxone wears off, the withdrawals will start again, and you'll need to redose. Quitting dope is sometimes a very long process - depending on the person - and suboxone is just a TOOL to get through that process; it is not a CURE.

My advice, take suboxone when you start to feel the discomfort set in for as long as you need to. When you feel like youre ready, start gradually lowering your dose (tapering) till you get it down to less than 1mg. When you get below 1mg, then youll be able to jump off the suboxone with very little, if any, withdrawal symptoms. You still wont be cured though, like I said. Staying clean requires a life-long change to your lifestyle. I suggest at the time of getting off suboxone, you seek therapy or counseling to get help in adjusting to this new lifestyle of sobriety.
 
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