1. Information in this forum is not monitored or provided by a medical professional. The information reflects member opinions only. Do not act on advice from these forums without first consulting a qualified medical professional. No professional addiction advisors are recognized by the owners, admins, or moderators, even if the member states such status. All content is copyrighted and protected. DO NOT use any information that can identify you in these forums. If you do, a google search can link your addiction post to your name causing harm to your future activities including employment.

Buprenorphine FAQ

Discussion in '~ Articles ~ Info ~ Links ~ Data ~' started by Bup4pain, Dec 30, 2003.

  1. Bup4pain

    Bup4pain Well-Known Member

    FAQ Link: http://opium.poppies.org/index.php?act=ST&f=18&t=1823&

    The Buprenorphine FAQ - Version 2.0 (bupe = Buprenorphine, 'done/mdone =
    methadone, as far as this document goes)

    NOTE: All of the information in this FAQ is relevant only to the USA unless
    specifically stated otherwise.

    First and foremost: Bupe is not a wonder drug! While I am writing this from
    a bupe advocate position, I will keep the facts objective. I have had
    wonderful experiences with bupe and as such it is only natural that I would
    think it's a good drug for maintenance (not getting high, although that
    doesn't mean a maintenance "buzz" isn't included.) Neither bupe nor mdone is
    better, period. It all depends on the person and their goals. (not just
    their goals, however, as bupe can work wonderful in certain people as a
    lifelong maintenance drug.) In general, using the limited facts and studies
    we have at the current time, it appears that 'done works on more people than
    bupe does, but by only a very small factor, and only at high doses of 'done
    (90mg+)

    Secondly, and most importantly: Opioids are can be extremely individualized.
    Some work for some, other work for others, all with different effects. With
    Buprenorphine this is multiplied by infinity. Every aspect of the drug can
    be VERY individualized (even the science of Opioids is poorly understood in
    a large regard, especially so in buprenorphine's case). One of the large
    reasons for this is the fact that the drug is a "partial agonist." These
    words ring fear into the ears of pharmacologists, as they try to this day
    understand the puzzle. On top of that, one person's experience with bupe
    will likely vary from day to day. I will get into this further later.
    Nothing said in this FAQ can necessarily be true to you. Please keep this in
    mind.

    What is Buprenorphine? What is the DATA?

    Buprenorphine, exactly like methadone, is a medication given to keep people
    off of heroin and improve their, and society in general's, quality of life.
    Buprenorphine's major clinical importance is as an agonist. Buprenorphine is
    *not* like Naltrexone (in terms of a treatment for opioid addiction.) It's
    antagonist/partial agonist nature is only important in the regard that it
    might effect how well it can do it's job as an agonist, and as a side bonus
    that it can blockade very effectively other Opioids (much like 'done, but
    much better.) This IS like Naltrexone, but it is not the primary clinical
    importance of the drug. For the reason it's a "partial agonist," it's
    regarded with less abuse, addiction, and diversion potential, and is
    schedule III under the controlled substances act which allows it to be
    prescribed by qualified physicians out of their offices as per the Drug
    Addiction Treatment Act of 2000 (abbreviated as DATA, and called as such for
    the rest of this FAQ.)

    What the DATA is, From SAMHSA (the Substance Abuse and Mental Health
    Services Administration):

    [The Drug Addiction Treatment Act of 2000 (DATA 2000) expands the clinical
    context of medication-assisted opioid addiction treatment by allowing
    qualified office-based physicians to dispense or prescribe specially
    approved schedule III, IV, and V narcotic medications for the treatment of
    opioid addiction. In addition, DATA 2000 reduces the regulatory burden on
    physicians who choose to practice opioid addiction therapy by permitting
    qualified physicians to apply for and receive waivers of the special
    registration requirements defined in the Controlled Substances Act.]

    What this means is that drugs approved for maintenance (which currently only
    included Methadone, LAAM, and Buprenorphine) that are in schedule III or
    above (which only includes Buprenorphine) can be given by qualified
    physicians (usually psychiatrists) directly out of their office (via
    prescriptions that can be brought to your pharmacy of choice.) This law was
    enacted (in 2000!) in order to help get more addicts into treatment by
    loosening some of the "klinik" restrictions, by eliminating the "klinik"
    completely in certain situations.

    Eliminating the fat:

    Can any doctor prescribe Buprenorphine?

    No. Only doctors who meet the (simple) qualifications, and then apply to
    SAMHSA (who then follows through with the DEA, who issues the doctor a
    second, special DEA number) may prescribe maintenance medications. See the
    "Practical Information" section for more...practical information, including
    finding a doctor. The qualifications are more of a red tape then anything
    else. All that is necessary at minimum is an 8 hour course (if the doctor
    meets none of the other requirements) and a short application. If you have a
    psychiatrist you know and like who isn't a part of this program, perhaps
    you can convince him to sign up.

    Does this mean that qualified doctors can prescribe methadone or LAAM?

    No. Both methadone and LAAM are in schedule II. Only Schedule III, IV, or V
    drugs may be prescribed by office physicians under the rules of the DATA.
    The drug must also be FDA approved for *opioid dependence*. Buprenorphine is
    the only drug that meets these criteria. There is no other drug your doctor
    may legally prescribe for maintenance.

    It is possible, and likely, that other drugs will come forth in the future
    that will meet this criteria, although most likely not anytime in the
    immediate future. Perhaps even methadone or LAAM will be rescheduled. That
    is fairly far out for the USA, however, although it is true of certain
    countries (Australia, for instance) (VERIFY.) It is doubtful that mdone (or
    LAAM) will be rescheduled due to the highly profitable kliniks that will go
    out of business, despite the fact that both have very little abuse potential
    (although fairly high diversion/addiction potential.) They (the 'done lobby)
    are partially responsible for Buprenorphine taking, what was it now, 10?
    years to be FDA approved, despite its already proven safety and it's
    efficiency in other countries for maintenance. They (the kliniks) were
    afraid of going out of business, with all their patients lining up for
    Buprenorphine. The thought that might happen is laughable, and the
    possibility of them using Buprenorphine in-house (as an option), without the
    stringent rules, would likely boost their revenues significantly.

    Note: just as Methadone Maintenance Treatment is abbreviated MMT,
    Buprenorphine maintenance treatment is abbreviated BMT.

    Bupe vs. Methadone:

    A lot of heroin addicts or methadone maintenance patients have preconceived
    notions that bupe won't work. That is just not true. Bupe is not in general
    inferior to Methadone. That is a widely believed myth. It's different, but
    not generally inferior. It all depends on you, personally. For some people
    'done will work better, for some 'bupe will work better, it's that simple.
    While the ceiling level for bupe is only equal to about 30mg 'done in
    potency, you can get it so that *you dose that twice a day or more*, and it
    reduces your tolerance! This is mostly due to its antagonistic/partial agonist
    nature. Because of this, it makes what would be equal to 30mg of 'done a
    hell of a lot more effective, in some people. *I am not saying bupe could
    ever be more potent than a full agonist. I am saying due to other factors it
    CAN in SOME cases work better.* Granted, it is likely very rare that bupe
    will get someone "higher" than 'done in general. It *can* work better
    though, if you give it time, and give you more flexibility. If you are on it
    long term and you are successful with it I am nearly positive you will get a
    buzz, given the fact that you were successful with it. This as always is
    individualized, and there are plenty of people who don't receive a buzz (but
    are usually on lower dosages.) I strongly believe either it'll work or it
    won't, once you give it time and find the right dose. Struggling on
    Buprenorphine therapy is unlikely. If it doesn't work, it doesn't work, and
    switching to methadone is a fairly simple process, the klinik will probably
    be happy to have you.

    A simple example of the possibilities of maintenance treatment: (4 possible
    scenarios of dependence, not including the guy who succeeds at abstinence
    the first go around. I don't think I've ever met him )

    Person A has an "ordinary" opioid dependence. He needs a dose of agonist to
    keep him maintained. Methadone works, at doses most likely anywhere in the
    double digits, and he is happy. Buprenorphine works and he is happy. He is
    the most likely to succeed with abstinence, but not necessarily so. Don't
    rule yourself out of this spot so quickly. This currently also includes the
    person who wants the least "opioid" necessary, but I will refine that for
    the next version.

    Person B has an "ordinary" opioid dependence, but her tolerance and
    addiction level is sky high. She needs a high dose of agonist to keep her
    happy. Methadone at normal levels isn't enough. She needs a dose (most
    likely) of 100mg or more to be happy on methadone. Had she tried
    Buprenorphine, it would have never reached her level of opioid dependence.
    She would have failed, and she would have relapsed or switched to methadone.

    Person C has a "special" opioid dependence. Methadone at any dose doesn't
    work. Buprenorphine doesn't work. I feel bad for her. Let's hope she can get
    into Holland.

    Person D has a "special" opioid dependence. He has a certain predisposition
    that makes him a good candidate for bupe. He is *likely* to have a high
    level of addiction, although this could depend on how long he has been using
    opioids, and which ones. He also is quite likely (but far from definitely,
    it's individualized like everything else) would have failed on methadone.
    Buprenorphine lowers his tolerance and addiction level, and seems to fit
    right, and gives him the proper maintenance that he needs.

    Now, the Person A and Person B scenarios I gave you are very typical. It's
    what you would expect. Person C is less typical, but is still there.
    However, the Person D scenario tends to be overlooked. While I can't prove
    that certain people have a predisposition to having success on
    Buprenorphine,
    I don't see how you could argue against it. Just look at how individualized
    opioid use is in general, and the responses people have to which drugs. What
    could be argued is just how often Person D comes strolling along.

    Exactly what criteria Person D is likely to fall into I don't know for
    certain. It is entirely possible that they would have failed on methadone.
    Don't rule out bupe because 'done didn't work. Also, I strongly believe
    tolerance has nothing to do with it. Hopefully future research will give us
    answers to these questions.

    I will give reasons for my beliefs as to what people would fall into the
    "Person D" category through this FAQ. See my personal experience and
    partial agonist (in pharmacology) sections especially for more information.

    Effectiveness of treatment:

    In many studies done SL 8mg Buprenorphine (a low-average maintenance dose)
    was shown to be slightly less effective as a maintenance drug than ~90mg
    'done. (keeping people in treatment and having clean urine.) It was shown to
    be much more effective than low dose mdone (~20mg.) It was also,
    interestingly, shown to be more effective than LAAM, which is a full
    agonist. (PROVIDE REFERENCE.) Given that 8mg is basically the lowest line in
    terms of dose for maintenance (4mg for maintenance is possible, even lower
    is possible but not generally speaking,) it can be fairly safely assumed
    that bupe is generally as effective as 90mg of 'done in terms of
    effectiveness as a maintenance medication, and can also be somewhat assumed
    that bupe, once it your body adjusts to it, at an optimal dose, is equal to
    about 90mgs mdone in potency for you vs. potency for some guy on 90mgs
    'done, however this is a major simplification.

    The 48 hour rule:

    There is one other difference to be noted. Bupe IS a partial antagonist
    (which I will address a little later.) This means (in this case) that within
    48 hours of dosing, you won't be getting high on any other opioids. So if
    you still plan to get high "once in a while," then bupe isn't for you. It's
    fairly easy to do and I've done it before without much issue, but it's not
    "fun." It's like the 'done blockade, but stronger. The only case where this
    "48 hour" rule doesn't apply (generally) is in the case of doses under 8mg.
    However, this is, like everything else, individualized. Just don't expect to
    be the exception. Generally speaking, it can take up to a week before
    another opioid agonist can exert it's 100% full effects.

    Less than daily dosing?:

    With recent data, it seems that Buprenorphine can be given with less than
    daily dosing, anywhere from every other day to bi-weekly still being
    effective in some people (PROVIDE REFERENCE). However, as always, this is
    very individualized, and with the recent laws in the US there seems to be no
    reason to attempt such a dosing schedule unless for some reason you want to
    (having a very slow metabolism for Buprenorphine for instance, which could
    possibly *lower* your ability to be maintained on Buprenorphine (more !=
    better once you reach that ceiling level,) in which case less than daily
    dosing would be a good idea.) Discuss it with your doctor. LAAM might also
    be an option in this case.

    Should I switch from 'done to bupe?

    Probably not. You WILL go through at least some withdrawals, and it won't be
    worth it, unless you really want out of the klinik or want to detox. If one
    klinik doesn't suit your needs, perhaps another will. If 'done isn't working
    for you though, then that doesn't mean 'bupe won't, and in that case also
    it's worth a try. However, a mdone -> bupe conversion can be tricky, and if
    bupe just doesn't work for you, you are in for a very rough week or so.

    Should you switch from 'done to bupe if you are going to detox? Absolutely!
    I see absolutely no reason why this should not be done. Buprenorphine detox
    has been shown to be very effective. 'Done withdrawals are TERRIBLE. Bupe
    withdrawals are a joke in comparison. On top of that, it will work sort of
    like an UROD (bupe will force the 'done out of your system,) while giving
    you enough opioid stimulation in your brain to help the withdrawals, at the
    same time. If anyone knows any reason why this shouldn't be done, I’d love
    to hear it, as I can't think of a single thing (unless of course 'done
    withdrawals aren't that bad for you, but I don't think I've ever heard
    anyone say this.) See the withdrawals section for more information.

    To further sum up:

    If you want to get off H, and have not been in maintenance, should you try
    bupe? Of course! It's very likely to work just fine on you. And if it
    doesn't, there is always 'done. It's your call, of course, but it isn't
    something that should be ruled out without at least a full investigation.

    Does bupe give you a "buzz"? YES, it does. (dependent on dose) Can you get
    high off of it? YES, you can (and if you say no, try telling that to the
    gigantic population in France that went from having a heroin problem to
    having a Subutex problem.) Is it as good for getting high as a full agonist?
    Of course not! As always, this is individualized, but not strictly linked to
    tolerance.

    Bupe is a very individualized experience. I strongly believe that it works
    the best on people with a certain type of predisposition to heroin use. It
    seems to fix certain broken indigenous opioid systems. Some people will
    LOVE bupe, and some people will find it ineffective. This is the way it
    goes.

    One final thing to note - I’m not 100% positive, but if you are on mdone a
    long time generally speaking the dose has to go up once and a while, yes?
    (not everyone, but usually or sometimes, right?) Well with bupe, once you
    find that dose you will never have to increase it. (VERIFY)

    General rules for starting Buprenorphine:

    Try to cut down as much as you can before starting bupe. If it's just for a
    day or two, it won't make that much of a difference.

    You must wait until you are *in* withdrawals before taking your first dose
    of bupe. If you don't, you WILL be *in* withdrawals after taking it, and it
    will be much less pleasant than if you wait. In general, with the short
    acting opioids, including heroin, this means (from your last dose) waiting
    at minimum 8 hours, but 12-24 hours is strongly recommended (sleep some of
    it out). This is THE most important thing when starting bupe. The longer,
    the better. The only potential downside is the rare case where bupe doesn't
    work for you *at all,* then it'll be longer before you can get a working
    dose of another agonist.

    When starting bupe, lower is better. Start with a dose of 4mg (SL), and work
    up slowly from there, with 2 additional doses of 2mg to a maximum first day
    dose of 8mg (just a general recommendation.) Exceeding 8mg during the first
    day will most likely just make you regret it, and is not recommended in any
    case. I am saying this for *your* well being, trust me.

    Your doctor will be in control the first three days, and give you your
    doses. Be completely honest with him and do what he says.

    In the case of methadone:

    It is strongly recommended that you lower your dose to 30mg or less. I think
    this is a little on the conservative side, but until further data is
    available; you shouldn't stray from this number. Methadone has a nasty
    backlash, as you probably know, so it's much better safe then sorry.

    It is strongly recommended that you wait 24 hours minimum (I STRONGLY
    recommend 48 hours in the case of 'done) before taking your first bupe dose.

    What to expect:

    This part is the most individualized. It depends on four things:

    1. Your level of opioid addiction

    2. The current level (amount) and state (time since your last dose) of your
    opioid of choice in your body

    3. Your reaction to Buprenorphine

    4. Dose of Buprenorphine (remember, less is best)

    Now, I honestly can't tell you what to expect. It varies far too much.
    Unfortunately since not only is it individualized it's weighing on a
    combination of four different things, it makes it nearly impossible to
    predict. I can promise you almost definitely you will go through at least
    some withdrawals, unless you really shouldn't be on Buprenorphine in the
    first place. These withdrawals will either come before or after your first
    Buprenorphine dose, depending on the above four things (see the guidelines
    for further info.) It most likely will be a mixture of both, but will weigh
    more to one side, and this will be mostly your choice.

    These withdrawals could last anywhere from 4 hours to 4 days. It is possible
    that you could have mild lingering withdrawal after this period. It is also
    possible that you could decide to wait it out and keep trying, making the
    withdrawals last longer. I will make a rough estimate and say average
    withdrawal lasts about 24 hours. I will search for more information on this
    (for the next version.)

    How long should you wait it out if you are struggling? My opinion - if you
    are still having major withdrawal symptoms after 4 days since your first
    Buprenorphine dose it's time to move on. It is unlikely that you will find
    Buprenorphine to work for you if you are suffering *greatly* after 4 days.
    If you are still having mild symptoms, this is normal. This is my opinion,
    and I will search for more information on this as well (for the next
    version.)

    In the case of switching over from 'done the above is not necessarily true
    as was already pointed out earlier. Dose (and your level of addiction that
    comes along with that) weighs in much heavier than with short acting
    opioids, and withdrawal time could be longer. See the guidelines for more
    information.

    Once again, this does not *strictly* depend on tolerance by any means.

    Side effects of treatment:

    There have only been 3 confirmed side effects from long term methadone
    maintenance treatment: Constipation, Sexual dysfunction, and Sweating.
    With Buprenorphine, you can expect the same. The constipation is still
    there, but not as bad as heroin (can't compare to mdone, will try to find
    more information.) The sexual dysfunction is definitely still there, I can
    unfortunately say that personally. I have never experienced the sweating,
    but there is no reason to believe it is not part of Buprenorphine
    maintenance. Its importance, however, is practically nothing. Unfortunately
    tolerance does not develop, or develops very little, to these three side
    effects of opioids.
    My Personal Experience:

    I personally am fairly certain I would have failed on methadone. My
    tolerance was so high that ANY dose of anything other than good heroin (1
    bag minimum) going straight into my *vein* did absolutely nothing. This was
    *good* quality dope, trust me. There was only one brand that I liked, the
    rest were no comparison. I took my last dose of H in the evening. The next
    morning I was sick as a dog (I smoked some opium later that night (the one
    before) to try hold the withdrawals longer. I didn't wait long enough.
    BAAAAD idea.) By the end of that day, I received my bupe dose and was a hell
    of a lot better. Those were the worst withdrawals I have ever experienced
    (before taking the bupe.) I was puking every 3-5 minutes, cramped so bad I
    couldn't hold a thought, kicking and screaming...it was actually like the
    movies. Anyway, the withdrawals were over by the end of day 2. In about a
    week, I started feeling *REALLY* high (I hadn't felt high in ages.) One
    night I was so high I nearly OD'ed (I was barely breathing and couldn't
    move,) it was the best high I’ve ever felt. Obviously, that ended fairly
    quickly, but it shows clearly that tolerance doesn't necessarily mean that
    bupe won't work for you. In fact IMO I think they will find it to be the
    opposite. I still get a buzz off 'bupe, and sometimes a fairly strong
    sedative effect, but rarely anything really nice, usually just a buzz.
    HOWEVER, it's different every day. It holds me every day, but some days are
    much better than others. That is my experience with bupe and my opinion.

    In case you are wondering, I've cheated twice. (two small binges.)

    I address my experience some more scattered throughout this document.

    Bupe Pharmacology:

    First of all I'd like to get something out of the way: there is a lot of
    conflicting data about bupe. (Miller et al., 2001) I think it has to do with
    many factors, dose being #1. On top of that, the concept of a "partial
    agonist" is poorly understood. This further emphasizes how bupe can be very
    individualized, and work differently every time you take it. A lot of the
    pharmacological information you may find may be outdated and incorrect.

    By the Textbook:

    Buprenorphine is a semi-synthetic narcotic opioid, derivative of Thebaine.
    It is a mixed partial agonist-antagonist. It is a mu partial agonist and a
    kappa antagonist (Subutex full prescribing information). At low doses
    (~100mcg-1mg,) it works as a full agonist, and is slightly selective for mu.
    At higher doses, the antagonistic property becomes more dominate (and the
    partial-agonist as well) and it is competitive. (Buprenex full prescribing
    information, (1), (Miller et al., 2001)

    Chemically, it is 1 7-(cyclopropylmethyl)-? - (1, 1-dimethylethyl)-4, 5-epoxy-
    18, 19-dihydro-3-hydroxy-6-methoxy- ? -methyl-6,
    14-ethenomorphinan-7-methanol, hydrochloride [5?, 7?(S)]- **

    It has a molecular formula of C29 H41 N04 HCl and the molecular weight is
    504.10

    Buprenorphine hcl is a white powder, weakly acidic with limited solubility
    in water (17mg/ML) (Subutex full prescribing information)

    ** Holy ****, that's all I’ve got to say. (excuse my language) What's up
    with the ?'s? Is it different in each molecule? Could this mean, even if the
    chances are extremely slim, that some molecules are more effective than
    others? Further mystery surrounding bupe, or just simple, clinically
    insignificant, biochem information that I don't know, who knows. Look
    forward to the answer next version...

    At the receptors:

    Bupe has a high affinity at all 4 major opioid receptors (mu, delta, kappa,
    and ORL1) (Miller et al., 2001, (1))

    Order of affinity (How much attraction to and how tightly it binds to each
    receptor):

    mu > kappa > delta > ORL1 (Miller et al., 2001)

    (delta has about 30 fold less affinity than mu) (Negus et al., 2002)

    Bupe is a partial agonist at mu, delta, and ORL1. It is a full and potent
    antagonist at kappa*. (Miller et al., 2001) It's efficacy at the receptors
    is related to dose. The higher the dose, the less efficacious it works, (1)
    until it reaches a dose (~32mg SL) where increasing it any more would make
    it work less efficacious, although more data is necessary. (See Bupe and
    Dose)

    Order of efficacy (how strong it works as an agonist):

    ORL1 (34%) > mu > delta (Miller et al., 2001,)

    The fact that it is efficient at ORL1 is very significant; as I don't think
    any other traditional opioids can stimulate ORL1 (this definitely includes
    morphine and heroin.) Unfortunately it has a very low affinity for it, which
    would require large doses to create a significant effect there. Fairly large
    doses have been attempted in limited studies with no interesting results,
    other than the apparent reversal of agonist effects. ( ) I Believe ORL1 has
    been shown to have similar effects to mu. Describing ORL1 is beyond the
    scope of this document and my knowledge.

    * There is a lot of conflicting studies in regards to kappa. Some say that it
    does indeed produce kappa agonism. This isn't the case, I'm fairly positive
    of it, but I'd like to know why this is. It possibly has something to do
    with in vitro testing, however the in vitro testing summary (Miller et al.,
    2001) has determined bupe to be a kappa antagonist. I look forward to
    finding further information on this, as always, for the next version...

    Bupe has an extremely long half-life at the receptors. It takes about a
    month for the drug to be completely removed from your system.

    Finally, Buprenorphine has a major active metabolite, norbuprenorphine,
    which has activity at the receptors. See metabolism for more information.

    General Pharmacological Information:

    Bupe has a slow onset of action, with peak effects taking place in
    approximately 100 minutes. (Suboxone full prescribing information.) The peak
    effects for methadone take place in approximately 120 minutes (VERIFY.)

    Bupe readily crosses the blood brain barrier, and is highly lipophilic.

    Bupe is about 10x more potent IM than PO (oral), which is about the same
    ratio as morphine. You CAN eat bupe, although there is no reason to do so.

    Sublingual absorption varies greatly, and can be anywhere from 25%-75%. ( )
    The same percentages can be applied to an IM/SL potency comparison. However,
    in most people, their personal variation from one dose to another is low.
    (Subutex full prescribing information)

    A comparison of bupe to 'done for respiratory effects found that bupe had a
    much higher incidence of respiratory depression *not* requiring medical
    intervention. Bupe can cause respiratory depression, but *very* rarely
    anything resembling life threatening. Both drugs decreased 02 saturation to
    the same degree. The chances of severe respiratory depression are increased
    via the injection route. (Suboxone full prescribing information)

    Bupe is a very safe drug for an opioid. Overdose is very difficult, even for
    opiate naive individuals. (Subutex full prescribing information)

    See "Bupe and Dose" for further information on this topic.

    Buprenorphine is approximately 96% plasma bound, primary to alpha and beta
    globulin (Subutex full prescribing information)

    Bupe has a mean half-life plasma elimination of 37h (this can greatly vary
    between people) (see metabolism for further information) (Suboxone full
    prescribing information.) The half-life of methadone is 15-22 hours,
    although recent data suggested this could increase with repeated
    administration, and be as high as 150 hours.

    Note about Suboxone: The Naloxone is present in a 4:1 ratio in both dosage
    strengths (8mg/2mg and 2mg/0.5mg). See "Subutex vs. Suboxone" for further
    information on the Naloxone component.

    Metabolism:

    Buprenorphine undergoes N-dealkylation into norbuprenorphine and
    glucuronidation. This is done by the cytochrome P-450 3A4 isozyme (Subutex
    full prescribing information.) Norbuprenorphine is an active opioid. It is
    similar to bupe from what is known of it, which isn't much. From one in
    vitro test, it has a very similar affinity to bupe. Norbupe is a full
    agonist at delta and ORL1 with a low potency, but bupe antagonizes its
    effects. This study also states that at the? - (mu?) and Kappa- receptors,
    both bupe and norbupe are potent partial agonists, with bupe having a low
    efficacy and norbupe having a moderate efficacy, which we know is not true
    (in terms of kappa), and makes me doubt this study. (Huang et al., 2001)
    Further studies are necessary, or more access to information for me.

    NOTE: Whether you take it orally or sublingually, approximately the same
    amount of Norbuprenorphine is bioavailability. If, for some reason, you
    would
    want to maximize norbupe and minimize bupe, oral would be the way to go.
    This shows that the first-pass liver breakdown is responsible for the low
    oral availability of Buprenorphine, quite similar to morphine. This also
    hints that *possibly* the reason for IV use resulting in a better high being
    the minimization of norbupe, but that is pure speculation.

    Inhibiting/Inducing P450 3A4 will cause differences to you personally on how
    bupe works. What those changes would be are impossible to say without
    further investigation. Unfortunately, this includes HIV protease inhibitors,
    just like 'done. It is doubtful any significant differences/problems would
    arise that dose adjustment wouldn't solve.

    NOTE TO CHEMISTS: There are several direct derivatives of bupe that are of
    much greater potential for use for pleasure, certainly worth a try to
    *experienced* people. I imagine this could be difficult, due to beep’s
    complex structure. I'd like to find out more information about this.

    Pregnancy:

    Bupe is very similar to mdone when it comes to pregnancy. The good part,
    however, is that neo-natal withdrawals are less, for obvious reasons.
    (Fischer et al., 1998) Bupe also being the unique drug that it is that very
    rarely causes tolerance would be less likely to cause problems related to
    neo-natal addiction later in life if such problems do indeed exist. I have
    not backed this up, nor has problems later in life have been confirmed
    (making this impossible to back up,) this is mostly assumption and logic. I
    am fairly certain if you become pregnant or are planning on becoming
    pregnant it will be recommended you switch to bupe, if this didn't require a
    major dose reduction. This, however, is 150% better told to you by a doctor,
    and a decision made with his advice.

    Partial Agonist?:

    Buprenorphine best classified as a mixed partial agonist-antagonist. Does
    the fact that it's a mixed -antagonist makes it weaker? Nope, in fact if
    anything it's a good thing (that it antagonizes, or rather doesn't agonize,
    kappa.) Does the fact that it's a *partial*-agonist? Yes. They are two
    different things as far as Buprenorphine's classification is concerned. Bupe
    is a *very* bizarre drug, mostly due to the fact that it's a partial
    agonist. I can't emphasize this enough. It has a ceiling for agonist
    effects (due to it's partial agonist nature), and, for example, 16mg is not
    twice as strong as 8mg.

    Bupe can also be classified a mixed antagonist at mu because it has a very
    high affinity, which means it pushes whatever is there off of the receptor
    and takes it's place, and it's partial agonist nature (low efficacy, to put
    it simply) means it can't do the job that was just being done. This can
    cause it to be classified as having mixed -antagonistic effects, however
    partial agonist is a better classification as long as the dose is proper. It
    doesn't simply have a "low efficacy", its better put as a "partial
    agonist." Read on for more theories on this.

    Taking a large enough dose of bupe, out of proper clinical dosing, can be
    enough to do a UROD, as it pushes all the opioids out of your brain (VERIFY
    AND PROVIDE REFERENCE). This is what causes the problem with starting bupe.
    You have to go through some withdrawals. See the part on starting
    Buprenorphine and methadone vs. Buprenorphine for further information.

    So what exactly does all this mean? It is easiest (and still largely
    accurate) to describe Buprenorphine as a normal opioid agonist with a
    sliding ceiling (by sliding I mean different in every person, and dose and
    effects aren't linearly linked.)

    See the section "Partial Agonist Theory" for more information on what
    exactly a partial agonist is, in theory (and in practice.)



    Bupe and dose:

    Bupe is a very weird in one regard when it comes to dose. As I already
    explained, double the dose doesn't equal double the effects. The reason for
    this is because as the dose goes up the efficiency goes down. (1) The reason
    for this is unknown, and related to partial agonist theory. I honestly wish
    I knew.

    Dose for highest efficiency: 0.3mg (IM.) At this dose, its effects are
    maximized and it behaves almost completely like a full agonist, acting equal
    to 10mg IM morphine in opiate naive individuals. (Buprenex full prescribing
    information)

    32mg is about the ceiling level. This ceiling level is different in every
    person (see bottom of this section.) For this reason, it is *possible* that
    in people who have a very low ceiling are those that would likely fail at
    Buprenorphine, but further information is necessary. Increasing the dose
    higher than this will have the loss in efficacy overtake this increase in
    amount in your system. Taking doses higher than the ceiling will eventually
    lower its effects, and taking very high doses will function as a straight
    up antagonist, (1) although again more information is necessary. (see below)

    There is one study to this regard available; in rats a dose of about 1mg/kg
    caused an end to increase in agonist effects and a linear reversal in
    efficacy. In the average human this would be a dose of about 80mg, which is
    way more than ~32mg. Obviously, since it's a different species, the numbers
    can't be applied. It does seem however that this same mechanism happens in
    humans, but at a lower dose. Further studies are necessary. (VERIFY AND
    PROVIDE REFERENCE)

    An 8mg-24mg dose is highly suggested for maintenance, depending on your
    personal reaction to the drug and dose. If you go over 16mg, I STRONGLY
    suggest you take it more than once a day.

    It is also important to say that 32mg is the *GENERAL* ceiling. This depends
    on the individual, but in every individual a ceiling was reached, and
    usually above 8mg. (Subutex full prescribing information.) So please
    remember, more doesn't necessarily mean better with Buprenorphine. If this
    is the drug for you, you will find the proper dose, and don't feel like you
    are getting jipped because you are only on 8-24mg.

    Tips for getting the most out of bupe: (This is one of the reasons I kept
    emphasizing this. I wanted to make sure people knew how to get the most out
    of it.)

    1. First and foremost, see "bupe and dose" in the above section.

    2. Cut your dose in half, and take it twice a day. This is because of
    efficacy as I just explained. By taking it twice, you get more bang for your
    buck, and it's long half-life makes sure that it's effects are cumulative
    the second time you take it. I strongly believe this makes a big difference.
    However, for you, as always, it could be different. Certainly worth a try,
    and definitely if your dose is over 16mg daily, or if it's just not working
    and you've reached the ceiling.

    3. Take your dose in the evening. I have personally found that when I take
    it in the morning, it leaves me wanting more and having very little effect.
    If I wait it out and take it later in the day, it works great. Granted, I
    have to be a *little* sick for about an hour or two, but it's nothing
    really, for me at least.

    4. Hold it under your tongue for longer than 15 minutes. At first it didn't
    take as long as it does now, it took about a half hour (to ABSORB, not to
    DISSOLVE.) Nowadays it takes at least an hour for it to absorb as best as it
    will. SL absorption varies greatly from individual to individual, which is
    one possible reason why bupe works for some people and not for others.

    How can I tell that it's absorbing and how long it takes? I have been taking
    this drug for several years. I can feel it tingle on my tongue. I can taste
    the drug in my mouth. If my tongue is in it, it will tingle. If I take my
    tongue out before it's done, it will stop tingling to some extent. This is
    how I can tell.

    You have nothing to lose by trying.

    I will add more as I think of them and find out about them.

    Partial Agonist Theory:

    A very fascinating section coming soon. This may help to explain the reasons
    bupe works the way it does, and may even in the future help to find a way to
    maximize the drug's efficacy. (Not my summary, the theory itself).

    Buprenorphine, Withdrawals, and Detox:

    There are two aspects to this, withdrawals when switching to bupe and
    withdrawals from quitting bupe.

    Withdrawals from switching to bupe:

    You do have to go through at least a little withdrawal if you are addicted
    to opiates. This is unavoidable. Now, if you are switching from heroin, it
    really isn't that bad. See "General rules for starting Buprenorphine" for
    further information.

    Buprenorphine withdrawals:

    Bupe withdrawals are mild at best (in comparison to other opioids.) For this
    reason, it is a great thing for people wanting to get off 'done but unable
    to deal with the withdrawals. Unfortunately, due to it's long receptor
    half-life like 'done, the withdrawals will last at least a month (although
    this too is individualized, and can be shorter.) Bupe has one major unique
    symptom of withdrawal that will be the centerpiece: this unbeatable fatigue
    that will outlast all the other symptoms. All of the other symptoms, except
    a few minor and not worth mentioning unique ones such as stomach grumbling
    are similar to other opioids. I have been told that the withdrawals are the
    worst during the first week and then proceed to lighten up a lot. Once
    again,
    individualized.

    It is strongly recommended you do NOT taper your dose really low before
    quitting. It doesn't work, and doesn't help. It'll make the withdrawals
    linger much longer. It is not a good idea. Reports of withdrawals cold
    turkey have been much more positive than taper attempts. (PROVIDE REFERENCE)
    The suggested dose to go cold turkey from is 4mg. Your body will take care
    of the rest (via the slow disassociation of the drug from the receptor,
    lasting quite a long time, creating an auto-taper.)

    I must say however, as I have in just about every other section, this is
    individualized. There have been people who have had bad withdrawals from
    Buprenorphine. In this case, a different strategy is warranted, *possibly*
    involving a longer and lower taper.

    Buprenorphine for detox:

    Coming soon.

    Subutex vs. Suboxone:

    OK, a lot of you hear "Naloxone" and get scared. The fact of the matter is
    that Naloxone is not absorbed sublingually. It is added so that people don't
    bang it. If you bang Suboxone, you will get very sick and will deeply regret
    it. There is no clinical difference between sublingual Subutex and
    sublingual Suboxone.

    OK, now to get a little more technical. A tiny tiny amount of Naloxone is
    absorbed. So little in fact, it wouldn't even qualify for ULD antagonist
    therapy (as told by my doctor, and Mike Strates, "inventor" of ULD Naloxone
    therapy, as I can't personally make sense of the numbers.) So, you ask, if
    it does nothing why are there two formulations? Quite honestly it's because
    the company wants more money. Supposedly the Subutex is supposed to be used
    for initiation so the Naloxone doesn't cause withdrawals. Quite honestly,
    this is a crock of ****. The pictograms you are absorbing is not going to
    make a difference to your withdrawals, it is downright silly. Doses of
    Naloxone at much higher levels have been shown not to cause withdrawals, so
    why would this ridiculously tiny amount do so? (PROVIDE REFERENCE)

    The company decided to push to get Subutex approved sometime in the middle
    of the clinical trials. This is one of the reasons FDA approval took so
    long! It was the company that pushed for Subutex - no one else.

    The difference in maintenance between Suboxone and Subutex is absolutely
    nothing. As someone who has taken both formulations for long periods of time
    at least twice each, I can personally say that from experience.

    Now, the fact that you are getting a drug that has another drug merely in
    there to prevent you from shooting it IS insulting. It shows a real lack of
    trust. But it's not really up to the doctor. This is the way the USA is, and
    there is no way around it. So try not to think about it, and just take
    comfort in the fact that there is no difference, even though, alas, you
    cannot try and shoot it (you were thinking about it, weren't you? See, a
    lack of trust is warranted )

    Practical information:

    First and foremost - SUBOXONE IS 100% AVAILABLE. We are still waiting for
    the Subutex, with no promise of a date from the company.

    Not every doctor is authorized to prescribe bupe. Any doctor who wishes to
    be only needs to take an 8 hour course, or meet any of the other easily
    meetable requirements. For this reason, I am positive bupe will be very easy
    to come by (in the near future.) When a doctor is "authorized" (s)he gets a
    second DEA number to be used for this purpose, which the pharmacy quite
    honestly has no way to verify unless they physically call up SAMHSA or the
    DEA.


    Here is a link to the doctor locator: (Note: Not every doctor authorized is
    listed here. Not every doctor listed here is competent.)

    http://buprenorphine.samhsa.gov/bwns_locat...ator/index.html

    Sadly, even though Suboxone is available, and the DEA numbers are issued,
    that doesn't mean getting into the program will be easy. Doctors have little
    clue of what they are doing, never mind what is going on. Pharmacies are
    skeptical of catering to heroin addicts. Let me address some of this.

    SAMHSA has been spreading misinformation. They have been telling doctors
    that Subutex/Suboxone won't be available for three months. If your doctor
    doesn't know the drug (Suboxone, not Subutex yet) is available, have him
    call 1-877-SUBOXONE. This is the company's helpline, and they will tell him
    all about it.

    Doctors are under the impression, thanks to Reckitt Benckiser (the company
    who makes Subutex/Suboxone,) that they should use Subutex for induction.
    There is no reason for this other than to be cautious for extreme
    hypersensitivity/allergy to Naloxone. (See Subutex vs. Suboxone for more
    information on this.) Be sure to tell him that you are not afraid to be
    inducted with Suboxone. For this reason, and for many others, doctors do not
    have their induction doses, and probably won't for several months. This will
    delay the majority of Buprenorphine maintenance a great deal.

    There is a solution, and Reckitt suggests it themselves: have your doctor
    write a script for 3 8mg tablets or so, and then you can bring it back to
    the office for induction or the pharmacy could deliver it. (Suboxone full
    prescribing information.) If he is willing or prefers to do inductions with
    Suboxone, have him/her call 1-877-SUBOXONE. They will connect him to
    warehouses in order for him to get his induction doses.

    Pharmacies are not going to have Suboxone in stock. They will most likely
    order it on a per prescription basis. This is even more the case because of
    its price, never mind its use. Be sure to keep this in mind. Almost all
    pharmacies have next day delivery, provided that it's not backordered (which
    it's not at the current time.) You should have your doctor call in this
    induction dose the day before so it will be available. Then we come to the
    next problem. Pharmacies don't want to cater to junkies. Most will be very
    skeptical. In major cities, this really isn't an issue, but in rich/suburban
    communities, this can pose quite a problem. Be sure to call around and try
    to find a good pharmacy. A good pharmacy will make your life a whole lot
    better, and you should not quit until you find one. I suggest you try and
    find one before finding a doctor, as he may bring this up.

    Moving on, here is a list of *approximate* prices. I have no idea whether
    your insurance will cover it, call them and ask. As of my last (and only)
    script for 'bupe, it came up as drug not found on my insurance. When further
    information is available regarding information I will provide it.

    (These prices are for a month supply (30 days) at the specified daily dose.
    I have *roughly* extrapolated these numbers from the price of the 8mg daily
    monthly supply, and as such the other numbers are far from perfect. This can
    also vary regionally, and by pharmacy. Some pharmacies offer discounts, 10%
    for such a large cost is not uncommon.)

    8mg - $175

    12mg - $250

    16mg - $340

    24mg - $510

    32mg - $650

    The average daily dose is 16mg. 32mg is NOT *necessarily* the best dose, due
    to pharmacological reasons, regardless of whatever your tolerance may be.
    (See "Bupe and dose" in the "Bupe Pharmacology" section)

    Bupe comes in bottles of 30 and is available in 2 strengths: 8mg and 2mg, in
    both Subutex and Suboxone formulations. They will likely come in the
    original bottle for as much as your dose is divisible by 30.

    The procedure for switching to bupe is simple. You go to the doctor's office
    the first 3 days where he administers a dose of most likely Suboxone. (S)he
    will likely have you in the office for 2 hours during the first dosing. The
    second and third days will be shorter. You will then go once or twice a week
    for the first month, and it is unknown how large a script you will be given.
    After the first month is up, you will get monthly supply scripts, once a
    month (obviously,) and will see your doctor (most likely) once a month for
    maintenance and once a week if you are receiving psychotherapy. Psychiatric
    fees are usually in the $200-300 range for one visit, at least in New York.

    Buprenorphine is a schedule *III* (not V) narcotic under the controlled
    substances act. This was changed recently. Bupe most definitely deserves to
    be a CIII, and I believe the prior scheduling (via Buprenex) was automatic
    due to it's relation to Thebaine, and has not been examined directly.
    (VERIFY)

    There is one other formulation that exists: Buprenex. (as was just
    mentioned) They come in 0.3mg/ml injection vials (possibly 0.6mg but I’m not
    sure.) They are very expensive I hear. It is important to note that Buprenex
    is NOT FDA approved for maintenance, it is approved for pain, and it IS
    illegal for that use (for your doctor (Special rules apply to opioid
    maintenance, see the first section). If you had a legit script, it's not
    illegal for you.) People have used it in desperation in the past, with mixed
    results, although generally the results are surprisingly favorable for such
    a small dose.


    Overseas:

    In some countries Subutex comes in 0.4mg strength as well. This has no
    practical use except for PRN (as needed) use during induction. This will not
    be happening in the USA (the doctor will personally induct you for the first
    three days, making this dosage unnecessary.) It could possibly be used for
    tapering purposes; however the only reason why one should taper so low is if
    they are having unusually strong withdrawals from Buprenorphine, which is
    uncommon. See the withdrawals section for more information.

    There is also another formulation, Temgesic, but it isn't available in the
    USA. It comes in 0.2mg and 0.4mg SL tablets. It's
    only use is for the same reasons listed above for the 0.4mg Subutex, and for
    pain, which is what it is approved for in the countries it's approved. It is
    interesting to note that Temgesic contains no listed inactive ingredients. I
    find it hard to believe it's nothing but Buprenorphine, however, as 0.2mg is
    barely visible to the naked eye if it is at all (VERIFY), and on top of that
    handling the tablets could easily cause destruction of the drug. The reason
    why this would be worth mentioning is because it is almost asking you to
    inject it. There is also Temgesic-NX, which contains Naloxone just like
    Suboxone. You do NOT want to inject that under any circumstances.

    And this leads us to our final topic, getting high...

    Getting high:

    YES, it IS possible to get high off of bupe. In France they have a HUGE
    problem with bupe being used illicitly, where they use bupe in abundance.
    Heroin has virtually disappeared and bupe has become the street opioid you
    are likely to find. Heroin does exist there, don't get me wrong, but Subutex
    seems to be far more popular (VERIFY.) I can't tell you exactly how they do
    it, I wish I knew myself. I can tell you that they sniff or bang it. Do NOT
    sniff or bang Suboxone, you will get very sick.

    There have 120-something or so deaths from bupe in France. Almost always the
    bupe was banged, and also almost always mixed with another drug, usually a
    benzo.

    It should be noted that respiratory depression is increased when the drug is
    injected. This shows that injection probably increases the euphoria aspect
    of Buprenorphine.

    The euphoric aspect of Buprenorphine appears to be increased by
    injection/sniffing. The drug IS highly lipophillic, which means it rushes
    the brain like heroin (and theoretically should provide a rush if not for
    its partial agonist nature,) however, and also due to its partial agonist
    nature (?), it has a very long onset of action, of approximately 100 minutes
    to peak effects.

    I feel 100% confident in saying that bupe works just fine for getting opioid
    naive individuals high. It's quite potent in that case, actually. The
    downside is its long onset of action, which can take 1-2 hours if taken SL.
    In this case, a dose from 0.2mg to 1mg SL works wonders, however even in
    opioid naive individuals overdose is difficult. Don't try it out, though!
    People HAVE died, and it will most likely be unpleasant at an extremely high
    dose. If you don't have a tolerance, 0.2mg SL should be your first dose. And
    give it time!

    I am *NOT*, nor will I *EVER*, say bupe is superior to a full agonist for
    getting high.

    A personal report of getting high on 0.3mg via IV in an opioid
    tolerant/non-dependent individual:
    http://www.erowid.org/experiences/exp.php3?ID=15694

    He compares it to Vicodin and Xanax all rolled into one, mild (without the
    rush, nod, or intense euphoria), yet glorious. This is just one account,
    however, and is far from what you will experience if you try.

    Another one:

    http://www.erowid.org/experiences/exp.php3?ID=13581

    This one uses Temgesic 0.2mg SL tabs. He had a very strong reaction to the
    1mg he took the first time, and enjoyed the rest of the bottle of 30, taking
    only one at a time. He takes them SL, as they are designed for.

    Getting high while on Buprenorphine is difficult to say the least. The drug
    can work with a fairly similar efficacy to oral Naltrexone in blocking opioid
    agonists. See the "48 hour rule" in Buprenorphine vs. Methadone for further
    information.

    This FAQ, while comprehensive for Buprenorphine (USA), is meant to focus on
    maintenance, not recreation.

    Bibliography:

    G Fischer, P Etzersdorfer, H Eder, R Jagsch, M Langer, M Weninger (1998).
    Buprenorphine Maintenance in Pregnant Opioid Addicts. European Addiction
    Research;4(suppl 1):32-36

    Miller W; Hussain F; Shan S; Hachicha M; Kyle D; Valenzano K J (2001). In
    Vitro pharmacological profile of Buprenorphine at mu, kappa, delta, and
    ORL-1 receptors.

    (1) Dum JE, Herz A. In vivo receptor binding of the opiate partial agonist,
    Buprenorphine, correlated with its agonistic and antagonistic actions. Br J
    Pharmacol. 1981; 74:627-33.Heel RC, Brogden RN, Speight TM et al.
    Buprenorphine: a review of its pharmacological properties and therapeutic
    efficacy. Drugs. 1979; 17:81-110. (IDIS 121541)Kareti S, Moreton JE, Khazan
    N. Effects of buprenorphine, a new narcotic agonist-antagonist analgesic on
    the EEG, power spectrum and behavior of the rat. Neuropharmacology. 1980;
    19:195-201.Sadée W, Richards ML, Grevel J et al. In vivo characterization of
    four types of opioid binding sites in rat brain. Life Sci. 1983; 33:187-9.

    Negus SS, Bidlack JM, Mello NK, Furness MS, Rice KC, Brandt MR. (2002?)
    Delta opioid antagonist effects of buprenorphine in rhesus monkeys.

    Huang P, Kehner GB, Cowan A, Liu-Chen LY (2001) Comparison of
    Pharmacological Activities of Buprenorphine and Norbuprenorphine:
    Norbuprenorphine Is a Potent Opioid Agonist J Pharmacol Exp Ther 2001 May 1;
    297(2):688-695

    Buprenex full prescribing information (USA)

    Subutex/Suboxone full prescribing information (USA)
     
  2. Jon

    Jon Well-Known Member

    Hello John,
    From reading this I see where you get the 10:1 ratio IM to Sup. I think however there is a misunderstanding, From what I read they are speaking of taking the dose oraly (swallowed) to IM, Further down the paragraph they speak to the effinency of Sublingual to IM at aprox 75% IM compared to 25% sublingual (read it again and see if I'm correct.) This would make an Im dose only three (3) times the strength of the sub. Therefore a 1cc IM 0.3 dose equals only 0.9 not 3.0. Please check over your FAQ post again but I beleave I did read it correctly. These are the same figures used in the MD prescribing course
    Just got back from my doctor today and he is in agreement that I should be stepping off in a matter of days. The next three days on 1/2 a cc and then off. He is of the opinion that dropping any lower serves no purpose except to prolong treatment unessacaraly.I'm Going to do it and hope he is correct. This will give me Ten days total on Bupe,
    enough to clean me out with out creating a new dependency.
    Please wish me luck everyone, I pray this works.
    Peace,
    Jon
     
  3. Bup4pain

    Bup4pain Well-Known Member

    Jon, Good luck..

    FYI the absorption rates are funky. The info in the FAQ which relates the higher rate sublingual is from the same study the info you got. (the FAQ is a conglomerate of info from different source material)

    There is a huge disconnect with dosages unless the 10x is used. At 25% the max *EFFECTIVE* doses are/would be exceeded, and problems occur. MD's need to better understand this. This is why so many here have had problems with the initial high dose they were on.

    Sublingual rates are different, as stated in the FAQ. I'm sure someone some time with the right dose could get 25%, while others may only get 10%.

    I think it's a crap shoot for dose control. IM is the way to really control the dose.
     
  4. Jon

    Jon Well-Known Member

    HELLO BUP,
    i AGREE WITH YOU COMPLEATLY (sorry for caps) One of my main contentions is that Drs continulsly give new patients much higher than needed doses, causing many things such as precipitating WD in new inducties and contributating to the continued addiction and much higher and much longer dosings than are needed for other patients. If you use for less than one, two weeks and your dose is 1cc (0.3) or .9 sub. then there should be no problem getting off. The same applies to people who use the subutex for less than two weeks and step off at a 1, maybe two cc dose At that point a lot shoud be physcological, albiet very entrenched emotional needs.. My point is that many Doctoes are pleased with patients who stay on the drug past the two week limit and are quite happy to see them stay on indefinitly. I still agree that IM dosing is far more accurate.
    Thanks for the luck. Down to 1/2 cc today and then off by friday.
    Be well
     
  5. cgdg

    cgdg Well-Known Member

    Hey Jon(s)...
    I think one of the problems is that everybody *reacts* differently to Buprenorhine/Subutex and requires individualized treatment based on their own physiological and pyschological needs.

    A lot is also contingent on which drug they're switching *from* as the half-life of Methadone and OC is much greater than that of Vicoden, Percoset, Heroin, etc.

    What's good for Jim-Bob ain't gonna necessarily work for Jethro. That's why you'll find so many variations of treatment.

    True, a lot *is* psychological...many doctors are of the belief that the patient must be *ready* to stay clean, and that a 1-2 week detox might be too quick and the patient therefore relapses due to intense cravings +...but believe me that the physical aspects will be real; nowhere near what they would've been had the "cold turkey" route been taken, but real just the same.

    And conversely, staying on too long could just be trading one addiction for another...as John/Bupe4pain has stressed the "window" for getting off the Buprenorhine is one that must be taken advantage of while open.

    I'm of the opinion that one should get on as LOW a dose as quickley as possible, and then use the balance of time as a period of 'adjustment' while setting up a good network of *support* for the impending difficulty of sobriety.

    I've found that *most doctors* (at least in my area) stress detox, and not maintenance...an important factor when choosing your doctor....had my doc been an advocate for maintenance, I'd have gone elsewhere....so it's an important choice, IMO, right from the outset of starting Buprenorphine.

    In any event, know that I'm pulling for "youse both...cuz youse is guys what-has class." :D

    Please keep us updated on your stopping Friday Jon...I'm really interested in how it turns out for you, and you'll be in my thoughts! May the force be with you!
     
  6. Jon

    Jon Well-Known Member

    cgdg,
    All I can say is thank you. Please know that I follow your progress and and have a bit invested in your success. To hear you wish me good luck would bring a tear to my eye, if I had that abilitiy.
    Yes I will keep you posted on my progress. please keep me informed how you are. And Pinkie, if you are out there give a shout,
    Be well Jon
     
  7. diavolo7

    diavolo7 Well-Known Member

    Hi Jon,

    Thanks for all the bupe info!

    I have a question about the 48 hour rule.

    I had a short but bad H addiction (sniffing, 3 months, 12 - 15 bags a day). I started suboxone yesterday. 16mg first day, today down to 12mg, tomorrow 10mg, etc. SHORT detox. I want off the stuff! I know I can do it. I feel 100% better today than yesterday (threw myself into acute withdrawal...not fun!).

    I want to know how long after my last day of suboxone (probably Tues 6mg) do I have to wait for any opiate to work (I take Fioricet w/codeine for migraines which I get maybe 4 times a month).

    Thanks!
     
  8. Bup4pain

    Bup4pain Well-Known Member

    Hollie,

    Yes, Buprenex Injectable is for Pain. I do not think the SL forms are approved for pain... maybe?

    I was on buprenex for chronic pain. It is the liquid injectable form. I was on two .3 mg Injections then progressed up to four .3 mg IM injections a day.

    Due to side affects I have quit and have gone back to morphine PO and am trying to get off.

    Buprenorphine has a low ceiling of pain control. It may control your pain. If not it will take 3-4 days before pure opiates will work again, as the buprenorphine will block the effects.

    Discuss the options if the bup is inadequate for your pain.

    Sorry to take so long to reply...
     
  9. spring

    spring Guest

    What is Sub?

    Most know this but some do not so am going to clarify this again...bup and sub are the same thing. Buprenorphine is the chemical name of the drug....some of the brand names are Suboxone, Subutex, Buprenex, and Tempgesic. I'm pretty sure those are all of the brands currently available.

    Buprenex is the liquid form. It comes in ampules and is taken either IM(muscle shot) or sublingually(held under tongue).

    SUBOXONE is buprenorphine with Naloxone added to it. Naloxone is also known as Narcan. (Narcan, BTW is the drug used to pull a person out of a heroin overdose). The Naloxone is added to the bup to keep people from shooting it IV. If Naloxone is taken IV it will send you into instant W/D. But, the Naloxone has no effect on you if you take the Sub as directed and that being UNDER THE TONGUE.

    Naloxone is NOT the same drug as Naltrexone. These are two different drugs with two different uses.

    SUBUTEX is buprenorphine only, no additives. Both versions of Sub are sublingual(dissolved under the tongue).

    TEMPGESIC is another version of Subutex. It is also sublingually used. I don't know much else about this drug except for I've heard it is an unstable and weak one.I do not know this first hand tho. The only people I know of who got this drug are ones who ordered it from overseas pharmacies before our country approved Suboxone/Subutex to treat opiate dependance.


    To read about Suboxone/Subutex

    click here www.suboxone.com

    To help in your search to find a doctor in your area who RXes Sub click here

    www.buprenorphine.samhsa.gov

    ~~~Do the right thing and risk the consequences~~~Spring~~~
     
  10. Pal

    Pal Well-Known Member

    This is from: http://buprenorphine.samhsa.gov

    Frequently Asked Questions About Buprenorphine and the Drug Addiction Treatment Act of 2000 (DATA 2000)

    1. How do I find a doctor who prescribes buprenorphine for the treatment of opioid addiction?

    2. Can buprenorphine be used to treat addiction to prescription pain relievers, such as oxycodone or codeine?

    3. Can Buprenex®, or any other medications besides Subutex® and Suboxone®, be prescribed/dispensed for opioid addiction treatment in practice settings other than Opioid Treatment Programs (OTPs) (i.e., methadone clinics)?

    4. I submitted my waiver notification to SAMHSA a few weeks ago and received an acknowledgment letter, but haven’t I heard anything since. How can I check on the status of my waiver?

    5. I am a waived physician and would like to add, change, or remove my listing on the SAMHSA Buprenorphine Physician Locator Web site. How do I do this?

    6. I am a waived physician, and I've moved my practice location since receiving my waiver. Do I need to notify SAMHSA or DEA of my new practice address?

    7. With a DATA 2000 waiver, can I prescribe Subutex® or Suboxone® for opioid addiction in more than one practice location? Can I dispense Subutex® or Suboxone® from more than one location?

    8. I've heard this new model for the treatment of opioid addiction referred to as "office-based opioid therapy." Does that mean that physicians with DATA 2000 waivers can use Subutex® and Suboxone® to treat opioid addiction only in the office-based setting?

    9. Are there specific Federal record keeping requirements for office-based opioid therapy?

    10. DATA 2000 limits the number of patients who may be treated for opioid addiction at any one time by a physician or a physician group practice. How do I know if my group practice or I are subject to those limits?

    11. Does HHS intend to issue regulations for different categories of group practices and different patient limitations for these categories?

    12. Can an Opioid Treatment Program (i.e., methadone clinic or OTP) dispense Subutex® and Suboxone® to patients admitted to the program? If so, is there a limit on the number of patients who can be treated with Subutex® and Suboxone® for opioid addiction treatment in an OTP? Is a DATA 2000 waiver required?

    13. Can the medical personnel in correctional facilities dispense (or administer) buprenorphine to incarcerated individuals?

    14. Can physicians and other authorized hospital staff administer buprenorphine to a patient who is addicted to opioids but who is admitted to a hospital for a condition other than opioid addiction?

    15. Can Physician Assistants or Nurse Practitioners prescribe buprenorphine for opioid addiction treatment in States that permit them to prescribe Schedule III, IV, or V medications?

    16. May physicians in residency training programs obtain DATA waivers?

    17. Where can I get a copy of the Buprenorphine Clinical Practice Guidelines?

    18. Are Subutex® and Suboxone® available in pharmacies?

    19. Do pharmacies need waivers to dispense buprenorphine?

    20. How can a pharmacist verify if a physician has a waiver to prescribe buprenorphine (Subutex® or Suboxone®) for the treatment of opioid addiction?

    21. Can Subutex® or Suboxone® be prescribed for conditions other than opioid addiction, e.g., pain control?

    22. Can buprenorphine be used to treat cocaine addiction?

    23. Can a person currently being treated with methadone switch to buprenorphine without suffering withdrawal symptoms?

    24. How much will a dose of buprenorphine cost a consumer?

    25. Will Medicare and Medicaid cover substance abuse treatment and buprenorphine?

    26. Will buprenorphine be available in treatment programs for indigent patients and patients who don't have Medicaid or Medicare?

    27. Where can I find out more information about buprenorphine treatment for opioid addiction?
     
  11. Pal

    Pal Guest

    Buprenorphine Curriculm for docs. Now You Know!

    This is the web site that contains the course your doctor took to get his certification to administer medications. It also contains a test in the lst section. It is 800 slides long, but some slides only have one word and it is a fast read if you are into it (I'm a dork kinda for this stuff).

    So, if you want to know what your doctor knows about this (which was less than I would have thought!!!!) ;) it is at:

    http://buprenorphine.samhsa.gov/bwns2/Buprenorphine_Curriculum.pdf
     
  12. Bup4pain

    Bup4pain Well-Known Member

    Take the course... Sure made me mad. The negative condescending little anti addict comments kept slipping in. They are almost giddy with delight about how Suboxone can cause instant w/d if abused, and are delighted with the blocking aspect of bupe. THAT is why they want us on high dose maintenance not low dose. Even if low dose is easier for us in the long run to get off of.

    Also the total lack of understanding about w/d astounds me.

    We are a sub human class.

    After taking the course I know why MD's lack REAL understanding about bupe and how to best use it. Just my ignorant sub human $.02 worth. You can sure tell the government had a lot to do with it too. GRrrrrr
     
  13. spring

    spring Administrator

    some more links to Sub info

     
  14. FoolishHeart

    FoolishHeart Well-Known Member

    thank you for this. very informative
     

Share This Page