[Rastopop]

Hi, all -

On my second bupe treatment. I used it in 06-07 to quit a 2-300mg/day oxy habit. Started on 20mg/day and tapered off over 7 months. It took much longer than I would have liked, but my shrink and I had different goals. He wanted to keep me on it forever (maintenance), and I'd rather die than stay on it.

Fell off the wagon a few months after. More accurately, I took a wild, running leap off the wagon. Not much falling involved.

Didn't get too bad - 60mg/day. But wanted to stop it before it got any worse, especially since I hated the high. It reminded me of the worst time of my life. But, as anybody who's ever had an addiction knows, there's nothing rational about it. You can hate it and think it's evil, but still be drawn to it. It's not intellectual - it's an appetite, and you can't reason with an appetite.

Because of the first addiction, I was terrified of trying to taper off the oxy. There are people out there who would tell me I was better off trying to taper off the oxy rather than switching to bupe, but everybody's different. I'm hypersensitive to this stuff, and I found bupe a much more comfortable taper, though I HATE the side-effects. And the effects themselves, I suppose.

I chose bupe again because I figured I would have a far easier time of it since my addiction was smaller, and that seems to be the case. Rather than starting off at 20mg/day, I started off at 8mg/day, and decided it was too much. I was nodding and puking. It was actually a great high, but totally counterproductive. I simultaneously loved and hated the high.

Bumped myself down to 6mg/day. Told shrink. He wanted me on 8, but I don't want to be high all the time.

Decided 6mg/day was too much, as I still felt high and was still puking a lot.

Bumped down to 4mg/day, and started to feel better. The taper from 8mg/day to 4mg/day took about two weeks. I've been on the stuff for about a month now, and I'm down to 3mg/day, and still trying to aggressively taper, accepting a bit of sweating and tearing in exchange for a faster detox.

So... the confusion.

I've read so much stuff about bupe that I'm having a hard time figuring out what's real and what's bogus. I've read things that are so completely stupid that I can dismiss them out of hand, but there are other things that aren't so obviously right or wrong.

Here's some of the stuff that's confusing me:

1. Bupe vs. oxy/morphine - Potency

My shrink keeps telling me that determining relative potencies is all but impossible with bupe vs. oxy.

This makes no sense to me, and I suspect that thinking comes from the bupe protocols docs are supposed to follow. For example, regardless of the size of your habit, the protocol apparently calls for induction at 8mg/day (at least).

I think thats nuts. I'd much rather have started at 2mg/day. If I got uncomfortable, I'd add 2mg every hour or so until I felt better, hopefully finding a sweet spot along the way that worked for me.

That is, I want to start at the lowest possible dose - not follow some one-size-fits-all 8mg/day starting protocol.

What I want to know - and what I think a lot of people want to know - is if there's a way to compare potency of, say, bupe vs. oxy. How much bupe is equivalent to how much oxy?

If I feel comfortable at 3mg/day of bupe, is that possibly, then, roughly equivalent to 60mg/day of oxy (the size of my habit)?

I realize it's difficult since the potency of bupe doesn't *feel* like it's linear. I mean, it doesn't *feel* like 8mg is only twice as powerful as 4mg (or whatever).

But, still... isn't there at least an approximation out there? There *must* be - there *is* an amount that would, once reached, cut withdrawals for the person depending on the size of their habit. But it'd be tough to figure this out if everybody's getting started at 8mg/day+.

I read a post by someone else who wrote that bupe is 40x more potent than morphine. I think that's just garbage. If it were 40x more powerful, 8mg would have killed me. Or at least knocked me out cold.

I think he got the potency confused with the affinity bupe has for the mu-opioid receptor, which is, from what I've read, about 50x that of morphine. But that has nothing at all to do with the *potency* of the drug.

So... does anybody have an answer for this? *Is* there a conversion chart? I couldn't find one. Nothing even remotely close.

The next thing...

2. Bupe is *way* harder to quit than oxy.

When I quit bupe the first time, I was in withdrawals for about a month, but only the first couple weeks were really difficult. Even then, the symptoms were totally manageable with benzos. That's not to say it was fun - I had an extremely difficult time sleeping. My doc gave me Seroquel, and the stuff pretty well knocked me out, but I was still aware of discomfort as I slept.

I had a feeling in my legs each night that made it feel like I *had* to run - for miles, and miles, and miles, and miles... stretching helped, but didn't solve it.

I did a lot of sweating. Tons. That sucked.

I was nervous, which is to be expected.

Had some depression - also to be expected.

But, like I said, it was only the first couple weeks that really troubled me.

However... *IF* bupe *is* harder to quit than oxy, then I'd rather switch back to oxy and taper off from that stuff instead. One of the nice things about short-acting opioids is that I don't have to feel the effects of an opioid all night and day. I hate this feeling - like I can't get away from the light high I get.

So... is it *really* harder to quit? Would any of you recommend that I switch back to oxy to quit? And don't worry about addiction - I'm *not* going back - I just want to end as comfortably as possible. I've made my decision, and I'm going to quit for good, and that's *that*.

It seems to me that it's possible that the people who think bupe is really hard to quit is that they didn't taper properly. I've read about people who went from, say, 1mg/day to nothing, and they had horrible, painful withdrawals.

I was cutting my 2mg subs into 1/8ths. Doing so, I was able to taper all the way down to .25mg/day.

I think this might be why my withdrawals weren't a total nightmare.

I don't think these people are aware of just how big a difference there is between 2mg of bupe and 1mg. When you go from 2 to 1, you're cutting your dose in half. That's obvious. But I've read things like, "I tried to quit and I was *only* taking 1mg/day, and it was bad, blah blah blah..."

Whatever the relative potencies are, it's obvious that bupe is much stronger, mg for mg, than oxy. It's like going from 20mg of oxy to 10mg. It's a *big* difference.

So... is it likely that these people had a hard time because they didn't "get" just how big a difference a 1mg shift in either direction is with bupe?

I want to quit, but if I can do so in more comfort with oxys than with bupe, then... well, I'd really like to know, and to get some clearer answers/info.

Thank you for taking the time to read this. I appreciate it. I know it was long, so I also thank you for your patience. I just try to be as clear as possible about these things, and that can translate to longer posts.

[benpharmer]

there is a bunch of reports about sub here
http://www.heroin-detox.com/default.asp
it is an active forum with a lot of conversation and reports about peoples sub use or experience

that being said, ill tell you what I know...I am in no way a medical professional.

1. the reason that bupe is so hard to compare to oxy is because it is a partial agonist, while OC is a full agonist. I have heard that 8mg of bupe is equal to about 60mg of methadone. To me, about 40-50mg of methadone gave me about the same effect of 80mg OC. Due to this, I would logically assume, for me, that 8mg of sub (which I am on right now) is equiv. to 100mg OC. That is ballparking it so give or take. Bupe is potent stuff that has a ceiling effect of about 16mg. Which means that 16mg would fill any receptors your brain could have. Bup will also increase your tolerance to other opiates (such as OC) so going back to OC to stop your habit may be hard, as after a month, you will probably have to take MORE OC to prevent withdrawals (mental mainly) than you were to get high. If you can deal with it and discipline yourself then go for it, most have problems in this area.

2. Many many people are starting to say that bupe is a beast to recover off of if you are on maintenance. There are a lot of people who said they did a 12-15day detox and it worked miracles, but many people on it over a month claim it to be the worst decision of their life. By what I gather, long term bupe use leads to about the same withdrawals as methadone, and the same length of withdrawals if not longer. Go to the boards listed above and read peoples reports, there is a sufficient amount of data gathered from people to make your decision.

If you are recovering from OC, and are serious about doing it, I would accept the fact that suffering is gonna happen in some form. Its the nature of the beast. There is no easy way. There is a quick way...stay off the sub or methadone. Since your on the sub, it might be wise to taper down to 2mg or less quickly, hang there for a couple of days, cut your losses and go "clean".

Either way, good luck. I am personally trying to quit MMT using sub. I am on a <1 month taper from sub, but methadone changes the rules.

[Rastopop]

Thank you for replying. I appreciate it. But, for anybody else who reads this thread, I wanted to make a couple corrections - one of the reasons I wrote this post was to try and clear things up about bupe, both for myself and others, so it's absolutely nothing personal - I just want to get as much Good Info as possible while trying to do away with whatever might be wrong.

Much of what I write here is the combo of things I remember reading, things I've been told, and other miscellaneous sources of info. I want to make it absolutely clear that, aside from having read a few books on the brain, addiction, and similar subjects, I have no idea what I'm talking about. Any confirmations/corrections would be much appreciated.

Originally Posted by benpharmer

1. the reason that bupe is so hard to compare to oxy is because it is a partial agonist, while OC is a full agonist.

If anybody else is reading this thread, could you please confirm this?

Because bupe is a partial agonist, I would expect it to make quitting *easier*. Being a partial agonist/antagonist that binds much more strongly to the receptor than oxy/morphine/etc., it:

1. Only partially activates the mu-opioid receptor.

2. Blocks other opioids from working.

It seems to me that #1 ought to help correct some of the downregulation that results from the constant full-blown agonist properties of traditional opioids of abuse.

I don't know what the actual mechanism is, but it's my understanding that your brain compensates for the unnatural activity caused by opioids by one of several (or a combination of) processes.

I remember reading that you wind up with denser clusters of mu-opioid receptors, and that some of these "extra" receptors don't actually activate anything, so the opioids bind, but nothing happens, and that's one of the reasons you need more and more. This is the result of *full* agonist stimulation.

With a partial-agonist, you aren't stimulating the receptor as much, so I'd imagine the brain doesn't have to compensate so much - it isn't being as stimulated as it is by full-agonist opioids, so that same level of downregulation wouldn't be necessary.

But, I dunno.

Originally Posted by benpharmer

I have heard that 8mg of bupe is equal to about 60mg of methadone. To me, about 40-50mg of methadone gave me about the same effect of 80mg OC. Due to this, I would logically assume, for me, that 8mg of sub (which I am on right now) is equiv. to 100mg OC. That is ballparking it so give or take.

Hm. That's definitely what I was wondering about. Maybe there isn't an easy conversion, but the "I have to take [x]mg of bupe to get the same effect of [x]mg of [opioid type]" is certainly better than nothing.

Another thing I wonder about, though, is whether it's linear. Let's just say for now that 8mg of bupe is equivalent to 45mg of methadone. Would 4mg, then, be the same as roughly 22mg of methadone? I'd love to know if anyone has the answer to this...

Originally Posted by benpharmer

Bupe is potent stuff that has a ceiling effect of about 16mg. Which means that 16mg would fill any receptors your brain could have.

Bupe's ceiling effect kicks in at 32mg, and my shrink says nobody really knows why that is.

Be interesting to find out why...

Originally Posted by benpharmer

Bup will also increase your tolerance to other opiates (such as OC) so going back to OC to stop your habit may be hard, as after a month, you will probably have to take MORE OC to prevent withdrawals (mental mainly) than you were to get high.

Interesting. Another thing I'd love to know is how long after stopping bupe you can take a typical opioid without its effects being blocked.

Bupe has, depending on whether you're a fast/slow metabolizer, a half-life of 37 hours. I'd guess that it takes a *long* time for it to leave your system - especially after regular dosing. The stuff must accumulate, so, when you quit, even if you're only taking 2mg/day, what you actually have in your system could be much, much more.

I bring this up because it might make it *seem* as though your tolerance for traditional opioids may have gone up, but in reality it's just bupe that's lingering... and lingering... and lingering......

Originally Posted by benpharmer

If you can deal with it and discipline yourself then go for it, most have problems in this area.

Think I might. I'll check out the link to the forums you provided to see how it's gone for others.

Originally Posted by benpharmer

Many many people are starting to say that bupe is a beast to recover off of if you are on maintenance.

Again, I wonder how much this has to do with the accumulation of bupe in your system. Quitting from a brief detox ought to have you starting from a far lower quantity of the stuff still in your system. Maybe that's why it's easier.

I'm experimenting with rapidly reducing my dose and dealing with the withdrawal symptoms with Seroquel. Seroquel works really well for me. I take it for going to sleep, but noticed that it did away with anxiety, tearing, and other withdrawal symptoms. Didn't decide until to day to take small doses throughout the day (25mg every few hours or so).

Originally Posted by benpharmer

There are a lot of people who said they did a 12-15day detox and it worked miracles

I told my shrink that that was what I wanted to do, but he used to work in a detox/rehab center, and he said that the people who did the quick detox felt fine at first, but that things eventually got bad, and they went right back to the opioids of abuse.

In his experience, he said that, depending on the habit, a 2-3 month detox is the easiest if detox is your goal. For high-risk addicts - those with a history of relapse - they generally try to get you on a maintenance program.

I'm trusting this shrink, though I'm still making decisions on my own about it this time...

Originally Posted by benpharmer

...but many people on it over a month claim it to be the worst decision of their life.

I absolutely hated the months of side-effects. That was the worst part. But quitting was definitely doable. What I'm trying to figure out is if it'd be easier to switch back to oxy now and then taper.

Originally Posted by benpharmer

By what I gather, long term bupe use leads to about the same withdrawals as methadone, and the same length of withdrawals if not longer. Go to the boards listed above and read peoples reports, there is a sufficient amount of data gathered from people to make your decision.

I had strong withdrawal symptoms for two weeks, followed by another two weeks of mild symptoms. I don't know how that compares to methadone. I just know that I'd like to get over it much more quickly this time... I miss my brain.

Originally Posted by benpharmer

If you are recovering from OC, and are serious about doing it, I would accept the fact that suffering is gonna happen in some form. Its the nature of the beast. There is no easy way.

Total agreement. I will say that, perhaps because I've done it before, I'm not as afraid of the pain this time. As you say, there will always be pain.

What would be wonderful... would be if the docs *knew* what they were doing and *knew* what the quickest, least painful route to Clean is.

I see the value in bupe, though. It breaks the cycle for me - the ritual of oxy. I *love* crushing, separating, swallowing, snorting, blah blah blah... that was half the fun. Doing away with that also does away with the ritual.

Just thought about that right now. Maybe that's one of the great benefits of bupe. I guess there's always a trade-off.

Originally Posted by benpharmer

There is a quick way...stay off the sub or methadone. Since your on the sub, it might be wise to taper down to 2mg or less quickly, hang there for a couple of days, cut your losses and go "clean".

Down to 2mg today. Gonna see if I can hold it there.

To get down to 3mg/day, I did 3mg/day for a few days, and took a little extra "booster" when I started to feel bad. That extra bit smoothed things out for a few days, and I think that's how I managed to cut down to 3mg/day fairly quickly.

I'm scared, though, you know? This stuff is scary.

Also optimistic. Hoping that overrides the fear.

Originally Posted by benpharmer

Either way, good luck. I am personally trying to quit MMT using sub. I am on a <1 month taper from sub, but methadone changes the rules.

Good luck to you, too.

Thanks very much for responding. I know things are different with methadone, and that I won't be able to do a 1:1 comparison between your experience and mine, but I hope that you write about your experience here.

[benpharmer]

i never said that bupe was easier/harder to quit because of the partial agonist, i was merely pointing out that it is hard to compare to a full agonist effects because it is a partial agonist.
on the note of why i think that bupe would be sooo much easier due to a 12-15 day detox is due to bioaccumulation..i have a calculator that someone sent me that shows the amoung of sub in the system. you just enter in the amounts on the days and the half life and it shows you how much you have. if, for example, you are continuously taking 12mg the in the body it builds up to 40-50mgs pretty quick before it levels out. so therefore, with the 37ish hour halflife, it takes a long time for it to get out of your system. that is why the w/ds linger for so long. its the longevity of the w/ds that make bupe hard, not the intensity.

as for the linear effects of bupe...i have often heard that less is more on bupe. therefore, it is more effective at lower doses. in my experience so far i can see this to be true. i get more of a "buzz" at 2-4mg than i did at 8-12. if, for example, 8mg =60mg methadone, then 2mg =30mg. i have no clue what the accuracy of this is, i am just trying to make a point about the nonlinear fashion of sub that i have heard/felt.

oh, and on a note about the easier/harder due to partial effects. i dont know if its the chemical makeup of the drug or partial effect that it has, but bupe has a much stronger affinity for the opiate receptors than other opiates, and thus it binds more aggresively. that is why even subutex can put you in precip. withdrawals if you dont wait long enough before your first dose. it wants those receptors and will kick anything out to get to them. food for though.
best of luck to ya

[Robert_325]

The bottom line is that shrinks don't have all the answers anymore than we do. We are all different and Buprenorphine affects us all differently like any other drug. I think it's BS to say that people who have relapsed or have used a long time need to do maintenance therapy with Buprenorphine. And I don't buy all the comparisons to different drugs and which is stronger and all that garbage. The time spent figuring all that out could be put into recovery and we could be done with all this.

I started on Subutex following multiple relapses and a 40 year addiction to mass quantities of everything. I was on an 8mg dose for close to a month. Then I started a rapid taper. I had previously suffered with PAWS and had all kinds of problems staying clean longterm. I tapered for about two weeks until I got down to less than 1mg a day and stopped at that point cold. I had maybe 6 weeks at the most involved with Subutex. Today I have been clean for a pretty long time. I had no problems with PAWS this time and have no desire to ever use again. I suffered no symptoms of any kind when I stopped the Subutex. I understand we are all at risk to change our minds and use again, but at this point in my life I don't see it happening ever. I have learned in my old age to turn to Christ for help when doing something like this, but I also have had to make choices myself too. Today I choose to stay clean.

I think anyone who can handle a quick and cold turkey detox from opiates should go that way and get it over with. For those who can't handle it or have repeatedly failed like me, then I believe Subutex or Suboxone therapy is great. We just have to use it properly and that varies some with the individual. I don't think many people have used more opiates than me or used any longer. I was doing right at 1000mg a day of OC plus huge amounts of Benzos, Somas, name it. And yes, my heart stopped several times and I nearly died over and over. It's just not necessary to use Subutex/Suboxone for an extended period of time in my opinion. If drs told us it was for detoxing only we wouldn't know the difference and that is how we would use it. I believe some of these drs are making huge amounts of money keeping patients on this therapy for a long time. It isn't necessary for us to use it that way. It works great for detox and there are NO symptoms whatsoever when we stop from using it properly. That is a fact. We can read all kinds of horror stories on this forum from people trying to stop Suboxone after a year or two of use. It sounds like they are detoxing from heroin. You won't find one single horror story from ANYONE who has used it short term and stopped. None of those people had any problems I promise you. Good luck.

[benpharmer]

Originally Posted by Robert_325

I believe some of these drs are making huge amounts of money keeping patients on this therapy for a long time. It isn't necessary for us to use it that way. It works great for detox and there are NO symptoms whatsoever when we stop from using it properly. luck.

i think this is the cause of a most, if not all, of the reasons that there are problems with sub. fact is, the pamphlet from the drug company on sub mentions only using it as a detox tool, but doctors, either greedy or misinformed, try using for maintenance like methadone. unfortunately, when used in maintenance like methadone, it carries with it long term problems when quitting like methadone. the acute w/d's may not be as bad as methadone, but the PAWS can last just as long.

[Robert_325]

Originally Posted by benpharmer

i think this is the cause of a most, if not all, of the reasons that there are problems with sub. fact is, the pamphlet from the drug company on sub mentions only using it as a detox tool, but doctors, either greedy or misinformed, try using for maintenance like methadone. unfortunately, when used in maintenance like methadone, it carries with it long term problems when quitting like methadone. the acute w/d's may not be as bad as methadone, but the PAWS can last just as long.

Ben ... obviously I pretty much agree with you. I would only add a couple of things as I want to be fair to everyone. I don't really approve of any maintenance drugs just for treating addiction itself. I advise against it to those in recovery. It's kind of contradictory. But that is just me personally. Methadone does have long term pain treatment benefits but Buprenorphine doesn't. I think we should work towards being off everything if possible. However, I know people who have used methadone a long time, I also know people who have used Buprenorphine for a good while too. While that type of therapy isn't what I would recommend, I would rather see addicts on methadone or buprenorphine long term than heroin, OC, RX opiates, etc breaking laws and ending up in jail ruining lives. But I have a big problem like you mentioned with drs cramming this down people's throats for long term use so they can make a bunch of cash off desperate people.

Patients need to get informed about all this and drs need to be policed more to make sure they aren't taking advantage of people or are not educated properly themselves. If a patient makes an informed decision after repeated relapses for example I would rather see that patient on a maintenance program than falling again. But that is about the only time in my opinion that maintenance drugs are justified just for treating addiction.