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Bupe Suboxone Mega Thread and FAQ v. 19

Get_Higher

Greenlighter
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Aug 11, 2010
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27
I see now, its no where close to a hard and fast figure. Thanks Jekyl :) I checked out the link you sent, do you have personal experience with liquid SL bupe?
 

mtop2036

Bluelighter
Joined
Nov 4, 2007
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281
Can someone tell me how strong subutex is in relation to methadone? If not known for methadone any other opiate would be ok. I've looked online but have found very different answers. I'd really like to know. Thanks
 

Get_Higher

Greenlighter
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Aug 11, 2010
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Most sources say around 50 percent but idk how they got that number. As in idk if that was crushed and snorted sub tabs or pure bupe. From personal experience vs IV, that figure is a good place to start, then factor in how well you though it absorbed, how much you lost, ect...
You may find that snorting a few smaller lines and using both nostrils as well as cleaning your nose before snorting to be helpful, and im not trying to patronize if you already knew. Hope this helps.
 

Jekyl Anhydride

Moderator: BDD, OD
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I'm experimenting with my suboxonne,IV and may try to smoke it,what's your thoughts?
Smoking Suboxone is a huge waste of Bupe aside from being fairly terrible for your lungs. While IV Suboxone does have the higher BA, it doesn't last as long and many complain that the up & down is far more difficult to manage. On top of that there is no rush from IV Subs/Bupe, but all the hassle of micron filtering and maintaining fresh supplies (when done properly). It's also been said by many that Subs are esp hard on veins.
 

Jekyl Anhydride

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Most prefer SL- sublingual or under the tongue after trying other methods due to the fact that the risk/ reward of IV or insufflation just isn't worth it. IV has no rush but leads to shorter periods of duration whereas waterlining is just a mess for little if any difference in effect. SL has a better AUC/ duration and def is best if you are using it regularly.

Here's a neat graph from a fellow mod:

I think this graph sums up the difference between i.v. and other RoA pretty nicely
 

mtop2036

Bluelighter
Joined
Nov 4, 2007
Messages
281
What is the best way to do Suboxone snort it or iv or under the tongue
I crush my pill and mix with a few drops of water. There is a thread somewhere around here with evidence that you absorb of of the drug, hence making it stronger. I personally would lower your dose a bit before trying. Plus I only have to hold it in my mouth for about 5 to 10 mins vs 10 to 20 with taking the pill normally.
 

Jekyl Anhydride

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I suppose this is more for the stretching of what they have or using without a prescription. Plus I'm all for adding a few drops of water or EtOH vs trying to move onto other ROA's for efficiency.
 

Nymeria

Greenlighter
Joined
Feb 28, 2019
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I know this gets asked allot. But asking for my situation. Took 4 mg bupe each day, for 3 days in a row. The last dose I took was a little over 24 hours ago. Will it be worth it to take my normal 40mg oxy now? Or is it to early? Normally i take 8mg of bupe but I wanted to take smaller til i got pain meds. I don't take oxy orally, bump it, idk if that makes a difference. Should I wait another day? Also I am female 5'10 and 170, if there is difference for sex height weight etc. Asking because I usually wait 3 days. Want to know if i can do as early as 24 hours. Thank you for your answers.
 

Jekyl Anhydride

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Hi Nymeria and Welcome to BL :)

The blocking effect of Subs can persist for quite some time and attenuate the effects of Oxy. The fact that you only used for 3 days might lessen the duration of the blocking effect but it's difficult to give an exact, " one size fits all" time frame regarding the clearance of the bupe. I would recommend that if you try to use a full agonist like Oxy after only 24 hours from your last dose of bupe, avoid trying to "break through" the bupe and just give it more time before trying again. While subs/ bupe are effective at blocking other opioids, if you reach a high enough dose of a full agonist you could be putting yourself at serious risk. At the very least it's a waste of Oxy. Patience is your friend in these situations. Stay Safe.
 

Nblakely

Greenlighter
Joined
Feb 18, 2019
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Does anyone know how long I should wait to do oxy if I injected 2mg of suboxone? Only been using suboxone for a few days and have always used iv administration.
 

Painful One

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Jan 18, 2017
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Can someone help me?
I'm really scared.
I live with chronic pain , cluster headaches, etc. and my doctor is going to change my medication from 75 mg MS Contin a day to Bupe next month. He says I am starting to get hyperalgesia with the morphine and thinks this will be a better change and will continue to control my pain.

I'm scared to death.

Will this be better for my pain and functioning? Am I going to be in hell?
I'm opiate dependent after 12 years of pain management with 75 mg MS Contin a day.

Please adivise, comfort, help. Tips.
 

mtop2036

Bluelighter
Joined
Nov 4, 2007
Messages
281
I think subs are just as good for pain as any opiate. Luckily your own a low dose of mscotin. I think you wouldn't need more than 2mg once a day or spread out through the day. Don't think you'll have any issues surveys being enough to cover your current dose. The worst part will be getting started and having to be sick before you start. It's really not that bad. I personally had problems but I was being switched from 8+ years of methadone.

Benzos can make the switch much easier but arnt necessary. You'll be okay I promise :) I'll try to answer any other questions you may have
 

Painful One

Bluelighter
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Jan 18, 2017
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Thanks mtop.
I really appreciate you answering.

This is scary stuff.
Hopefully this will be a change for the better.

I keep running out early of the MS Contin for the last year as I have needed a dosage increase but that got me the choice of cutting the MS Contin to 60 mg a day (I can't do it) or the suboxone. At least I won't be constantly running out early with the suboxone. I can't keep going into withdrawal every month for a day or two. Something has got to change.

I will have to go through a day or two without the MS Contin before starting the suboxone?

How long will I have to go without any medication?
Could I take some Loperamide during that time?

I will keep reading up on the suboxone. See what I can learn.
I have a month before I have to change but I'm so nervous.

Thanks for being here guys.
 

Jekyl Anhydride

Moderator: BDD, OD
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*I will have to go through a day or two without the MS Contin before starting the suboxone?
*How long will I have to go without any medication?
*Could I take some Loperamide during that time?
Don't use Loperamide as a bridge between the MS and Bupe, it has a long half life and will make the induction rough. There's two schools of thought on induction, one says that you can switch after 12-18 hours and if you have PWD's then just ride them out with more bupe. The second is to get up to a really high COWS-(Clinical Opiate Withdrawal Scale) score and then go through induction as it has a much lower incidence of PWD's.

The first school of thought is geared towards people getting off of opioids and onto ORT, they're worried that if people wait till they have a high COWS score (withdrawal intensity score) that the chance of relapsing and not inducing bupe at all is higher, and not worth the risk. So they push for shorter purge times. I personally think induction with small amounts is best, but you should research for yourself and share your thoughts with your doctor. Sometimes pure buprenorphine (Subutex) is tolerated better than buprenorphine + Naloxone (Suboxone).

It's good that you have some time to study up on how to best transition and utilize Bupe. Here are some good research papers on the subject.


When patients have a mild to moderate COWS score of 12 to 16, they are ready for the first dose. Some providers go as low as 5 or as high as 24 on the COWS scale, but ideally > 10. Abstinence timing for short-acting is 12-16 hours. Guidelines suggest that withdrawal symptoms are the more important indicator than a specific number of hours of abstinence. Maximum first day dose is now 16 mg/ previously it was 8 mg.

Precipitated withdrawal (withdrawal from not having gone long enough without the opioid of dependence before starting buprenorphine) can be managed in two ways.1) Continue induction with additional doses of buprenorphine until withdrawal abates, up to the recommended target dose of the formulation you are using. 2) Or stop induction and treat withdrawal symptomatically as above (especially clonidine, antidiarrheals, nonsteroidal anti-inflammatory drugs). Have your patient continue abstinence from the opioid of dependence and re-induce on buprenorphine the next day.
Buprenorphine Training Activity v5.0 For Physicians

Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method

There is considerable between subject variability in sensitivity to buprenorphine's antagonist effects. Low, repeated doses of buprenorphine/naloxone may be an effective mechanism for safely dosing this medication in persons with higher levels of physical dependence.
Conversion of chronic pain patients from full-opioid agonists to sublingual buprenorphine.
After initiation of buprenorphine SL therapy for more than 2 months, the mean pain scores on a scale from 0-10 decreased by 2.3 points (P < 0.001). Patient Quality of Life (QoL scale) was not significantly affected by buprenorphine SL therapy (P = 0.14). The success rate was highest for patients using morphine, oxycodone, and fentanyl before buprenorphine SL induction.

These patient groups had a 3.7 point decrease in pain for those taking morphine, a 2.5 point decrease in pain for those taking oxycodone, and a 2.2 point decrease for those taking fentanyl. Patients taking between 100-199 mg morphine equivalent per day experienced the greatest reduction (2.7 points) in pain scores.Patients previously taking morphine, oxycodone, and fentanyl had the greatest decrease in pain after conversion to buprenorphine SL.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675640/ Efficacy of Bupe for chronic pain
 

Painful One

Bluelighter
Joined
Jan 18, 2017
Messages
1,107
Thank you Jekyl A.

I am hoping my pain goes down with this change and the information you posted gives me hope for that.
I appreciate you taking the time to give me some links to study and learn about this.

Much love to you!
 
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