daddysgone
Bluelighter
- Joined
- Oct 22, 2007
- Messages
- 1,114
I am of the school of thought that in nearly all cases, bupe doctors prescribe absurdly and unnecessarily high doses of bupe for their bupe maintenance patients.
For instance, when I first went to my bupe doc, he started me at 16mg per day (and this is a lower dose then what many patients are prescribed).
For the first 2 weeks, I took the 16mg per day, and while I felt completely "held", I also noticed that I experienced quite a bit of drowsiness and dizziness at this dosage.
After about 2 weeks at this dosage, I decided to see what would happen if I took 4mg per day (2 doses of 2mg per day). On that day, I noticed that I felt 100% as "held", noticed NO feelings of even minor withdrawal, and also noticed that my drowsiness and dizziness almost completely disappeared.
After a few days at this dose, I cut my dose again to 2mg per day (1mg taken twice a day). Again, I felt just as comfortable, and all drowsiness/dizziness were gone. So essentially, I had cut my original dose down to 1/8th of what I was prescribed, and the result was that I felt just as "held" and comfortable, and any side-effects I had experienced at the higher doses, completely disappeared.
Now, if this was just my experience, I would not draw any grand conclusions since one person's experience is meaningless. However, again and again, I read reports which mirror mine exactly. Even for people who had very high opiate tolerances, nearly all seem to cut their doses to 2-4mg per day MAX, and suffer no decrease in effectiveness, and actually find that the lower doses are more comfortable and effective.
So at my bupe appointment today I decided to tell my doc that I have been taking only 2mg of bupe per day (he still scripts me for 16mg per day). Now his first concern was what was I doing with all the excess bupe (I imagine he was concerned I was selling them). After I explained that I have just been saving them and would never consider selling them, he seem satisfied and then wanted to have a discussion about dosages and hear my side of the story regarding why I felt that such a smaller dose is almost always sufficient, and in fact, often more effective. He also wanted to hear my thoughts regarding why the literature indicates that such high doses should be used, if its the case that so many patients feel thatmuch smaller doses seem to be just as, if not more effective.
I gave him my point of view/theory regarding why the manufacturers advocate such high doses of bupe when it seems that these high doses are counter-productive.
My first response was based on simple economics. Clearly the manufacturers of bupe stand to earn higher profits if they convince bupe doctors to prescribe high doses of an expensive drug. I also provided a less sinister reason based on the idea that at high doses, it becomes very hard for addicts to abuse other opiates since bupe effectively blocks other opioids at high doses, whereas addicts can fairly easy take full agonists on top of their bupe if they are on small doses of bupe. With that in mind, it does seem a legitimate reason to prescribe higher doses of bupe in order to prevent the abuse of other opioids while on bupe.
Lastly, I suggested that because bupe is a partial agonist, and is fairly unique in that unlike most other opioids, high doses of bupe really dont cause higher levels of euphoria or levels of abuse then they do at small doses. This, coupled with the fact that unlike full agonists, high doses of bupe are very unlikely to cause a dangerous overdose. So with these facts in mind, there really are no downsides (from the manufacturers perspective) of prescribing high doses of bupe, while they to stand to benefit (profit) from convincing docs to prescribe high doses of this expensive drug.
So....first Id like to know if people generally agree with all I have said on the matter. I truly feel that for those that find success with bupe (note that there do seem to be some people who cannot be "held" from bupe regardless of dose), but for those who find success with it, I am convinced that 4 or perhaps 6mg MAX per day, is a completely sufficient maintenance dose. I find it hard to believe stories of people who suffer pain and withdrawal from a 4-6mg dose, but then find a 20mg dose per day, to be effective.
The other question I want to ask is if anyone thinks it was a bad idea, for any reason, that I had this conversation with my bupe doc. I didn't want to insult him by implying that I am more knowledgeable on this subject which he is alleged to be an expert, but the truth is, I think most of us on bupe maintenance are indeed more knowledgeable about this subject, simply because of the practical experience we have with it.
I really just wanted to share my views with him because I am angered by what I view as deliberate deceit on the part of the makers of bupe. I genuinely believe they purposefully have spread false info regarding their product in order to increase their profits. I therefore felt compelled to give him an opposing view from an educated patient so that he is now exposed to both sides of this issue, and is now no longer only aware of the BS that the manufacturers of bupe have convinced him of.
So...did I overstep my bounds? Should I have kept my opinions to myself? Thanks-DG
For instance, when I first went to my bupe doc, he started me at 16mg per day (and this is a lower dose then what many patients are prescribed).
For the first 2 weeks, I took the 16mg per day, and while I felt completely "held", I also noticed that I experienced quite a bit of drowsiness and dizziness at this dosage.
After about 2 weeks at this dosage, I decided to see what would happen if I took 4mg per day (2 doses of 2mg per day). On that day, I noticed that I felt 100% as "held", noticed NO feelings of even minor withdrawal, and also noticed that my drowsiness and dizziness almost completely disappeared.
After a few days at this dose, I cut my dose again to 2mg per day (1mg taken twice a day). Again, I felt just as comfortable, and all drowsiness/dizziness were gone. So essentially, I had cut my original dose down to 1/8th of what I was prescribed, and the result was that I felt just as "held" and comfortable, and any side-effects I had experienced at the higher doses, completely disappeared.
Now, if this was just my experience, I would not draw any grand conclusions since one person's experience is meaningless. However, again and again, I read reports which mirror mine exactly. Even for people who had very high opiate tolerances, nearly all seem to cut their doses to 2-4mg per day MAX, and suffer no decrease in effectiveness, and actually find that the lower doses are more comfortable and effective.
So at my bupe appointment today I decided to tell my doc that I have been taking only 2mg of bupe per day (he still scripts me for 16mg per day). Now his first concern was what was I doing with all the excess bupe (I imagine he was concerned I was selling them). After I explained that I have just been saving them and would never consider selling them, he seem satisfied and then wanted to have a discussion about dosages and hear my side of the story regarding why I felt that such a smaller dose is almost always sufficient, and in fact, often more effective. He also wanted to hear my thoughts regarding why the literature indicates that such high doses should be used, if its the case that so many patients feel thatmuch smaller doses seem to be just as, if not more effective.
I gave him my point of view/theory regarding why the manufacturers advocate such high doses of bupe when it seems that these high doses are counter-productive.
My first response was based on simple economics. Clearly the manufacturers of bupe stand to earn higher profits if they convince bupe doctors to prescribe high doses of an expensive drug. I also provided a less sinister reason based on the idea that at high doses, it becomes very hard for addicts to abuse other opiates since bupe effectively blocks other opioids at high doses, whereas addicts can fairly easy take full agonists on top of their bupe if they are on small doses of bupe. With that in mind, it does seem a legitimate reason to prescribe higher doses of bupe in order to prevent the abuse of other opioids while on bupe.
Lastly, I suggested that because bupe is a partial agonist, and is fairly unique in that unlike most other opioids, high doses of bupe really dont cause higher levels of euphoria or levels of abuse then they do at small doses. This, coupled with the fact that unlike full agonists, high doses of bupe are very unlikely to cause a dangerous overdose. So with these facts in mind, there really are no downsides (from the manufacturers perspective) of prescribing high doses of bupe, while they to stand to benefit (profit) from convincing docs to prescribe high doses of this expensive drug.
So....first Id like to know if people generally agree with all I have said on the matter. I truly feel that for those that find success with bupe (note that there do seem to be some people who cannot be "held" from bupe regardless of dose), but for those who find success with it, I am convinced that 4 or perhaps 6mg MAX per day, is a completely sufficient maintenance dose. I find it hard to believe stories of people who suffer pain and withdrawal from a 4-6mg dose, but then find a 20mg dose per day, to be effective.
The other question I want to ask is if anyone thinks it was a bad idea, for any reason, that I had this conversation with my bupe doc. I didn't want to insult him by implying that I am more knowledgeable on this subject which he is alleged to be an expert, but the truth is, I think most of us on bupe maintenance are indeed more knowledgeable about this subject, simply because of the practical experience we have with it.
I really just wanted to share my views with him because I am angered by what I view as deliberate deceit on the part of the makers of bupe. I genuinely believe they purposefully have spread false info regarding their product in order to increase their profits. I therefore felt compelled to give him an opposing view from an educated patient so that he is now exposed to both sides of this issue, and is now no longer only aware of the BS that the manufacturers of bupe have convinced him of.
So...did I overstep my bounds? Should I have kept my opinions to myself? Thanks-DG