Thread: Suboxone (buprenorphine/naloxone)

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    Suboxone (buprenorphine/naloxone) 
    Bluelight Crew Tommyboy's Avatar
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    Dec 2009
    The wiki currently just has a page for either buprenorphine or naloxone, but I think that there are so many people asking about suboxone on BL, that it should have it's own page. This is also because people often ask if the naloxone is active in suboxone, or if it will put you in precipitated withdrawals if you IV it. Therefore, I will start this page, and see if others can contribute if I run out of steam.
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    Bluelight Crew Tommyboy's Avatar
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    The Basics

    Introduction and Basic Description

    Suboxone is a pharmaceutical drug that is a combination of buprenorphine and naloxone, and is used primarily to treat opiate addiction.
    Buprenorphine is a thebaine derived opioid agonist and antagonist, while naloxone is an opioid antagonist. Due to its higher affinity to the opiate receptors, buprenorphine essentially "out competes" the naloxone, rendering the naloxone inactive.

    Timeline of Experience
    Buprenorphine has a very long half-life (~37 hours) making the effects often noticeable into the following day.
    Onset 0-30 minutes, peak T+2, plateau T+3, Afterglow T+16, end of experience T+24.
    This timeline will vary depending on ROA.

    Since buprenorphine is a thebaine derivative, most people find it to be one of the more stimulating of the opiates, next to oxycodone (also thebaine derived). At first onset, the user will usually feel a warmth come over their body, and may have flushed skin. Pupils will become constricted (as they usually do with opioid use) as euphoria is felt by the user.
    Those that find Suboxone to be stimulating will often enjoy talking a lot more than usual, while feeling very empathetic. They may feel energetic which may lead to them cleaning or doing other chores that one would normally not enjoy.
    Those that find Suboxone to be depressing or "noddy" will feel euphoric and content with where they are.
    The euphoric effects of this drug will usually diminish as tolerance increases, and those that use this drug daily for opiate maintenance usually report feeling very little euphoria after stabilizing on a dose.
    Taking breaks from this drug may result in a brief return of the euphoric effects, but the user will often have to experience withdrawal during this break.


    Suboxone prescription:
    Suboxone is currently available in two doses.
    8mg buprenorphine/2mg naloxone
    2mg buprenorphine/0.5mg naloxone

    The buprenorphine in Suboxone is a very potent drug. Taken sublingually (under the tongue), effects from dosages as small as 1mg are felt. Other routes of administration (ROA) with higher bioavailabilities allow for an even lower dose to have an affect on the user.
    The ceiling dose of Suboxone is said to be ~32mgs, which is the highest dose prescribed.

    Method of administration
    Describe method. This should generally be a link to an individual page describing that method (e.g. IV, orally). Add in this section anything that is relevant to that method FOR THIS DRUG.
    Due to the change from pill form to strip form, preparing Suboxone for any ROA other than sublingual use will vary.


    Contraindications and Overdose
    Respiratory depression is not as big of an issue with Suboxone, as it is with other opioid drugs.
    As with any CNS depressant, it is dangerous to combine Suboxone with other CNS depressants (alcohol, benzodiazepines, barbiturates, etc).

    Something that is somewhat unique to Suboxone is its ability to cause precipitated withdrawal in those that use Suboxone while other opioid drugs are still on their opioid receptors. The other thing that is somewhat unique to Suboxone is its "blockade effect," which prevents other opioid drugs from becoming active since they cannot bind to the receptors.
    For these reasons, one should be extremely cautious when using other opioid drugs before or after taking Suboxone, and should wait the appropriate amount of time between dosing Suboxone and other opioid drugs.

    How Long To Wait.....?
    1. How long after taking my Suboxone do I have to wait before getting high off of a different opioid?
    2. How long after taking a different opioid do I have to wait before taking Suboxone without risking precipitated withdrawals?

    These two questions are some of the most asked questions on Bluelight.
    There are several variable that come into play when trying to answer this question, and in the end, everybody is different so it's hard to know.
    As for question 1, one of the main variables is if the person has been taking Suboxone regularly, or if they just took it once. The other variables, of course, are dosage and ROA. Daily users of Suboxone will generally have to wait longer to be able to feel other opioid drugs than someone that has only taken Suboxone once. The general rule of thumb is to wait 36 hours before taking another opioid, however there are people at the far end of each spectrum. Some people are able to get high the same day (~12 hrs later) and some have to wait ~72 hours before feeling the full effects of another opioid. ROAs such as intravenous may allow for a waiting period on the short side of the spectrum since the drug is eliminated faster that way.

    As for question 2, this two has several variables. The half-life of the other opioid drug previously taken is one of the main variables, and the longer the half-life, the longer you should wait. In clinic settings, people who are switching from Methadone to Suboxone have to wait 3 days after their last dose of Methadone, to be dosed with the Suboxone. One general rule is to wait until you are in moderate withdrawal before taking Suboxone, but for drugs such as Methadone that have long half-lives, this may not apply.

    Negative Short-Term Side Effects
    Headache, drowsiness, trouble sleeping, trouble urinating, itchiness, and dry mouth.

    Negative Long-Term Side Effects
    Constipation, weight gain, and fatigue.

    Addiction and Withdrawal Issues

    Although Suboxone is used to treat opiate addiction, it is also a drug with the potential for abuse. Physical dependence is an issue with just about every Suboxone patient since they use it daily. When one decides to end their Suboxone treatment, they should work out a tapering schedule with their doctor. The withdrawal from Suboxone is often reported to be longer and more drawn out than most other opioid drugs, but less intense if the patient tapers properly.
    Harm Reduction
    Use micron filters if you choose IV as you ROA.
    Do not combine this drug with other CNS depressants, other than those that your Suboxone doctor permits.
    Do not drive or operate heavy machinery until you know how this drug will affect you.

    Legal Issues
    Schedule III (V some states)[1] (USA)
    Schedule 8 (Aust)
    Class C(UK)
    Cat. A Singapore
    Schedule III Germany
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    Bluelight Crew Tommyboy's Avatar
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    Dec 2009
    Here is what is left, and also feel free to point out anything that may be wrong with my information.
    Note: This is from the MDMA template page, so ignore any of the stuff it says under the titles. Just use the general description of what type of stuff should be written.

    Background and Chemistry

    History of Drug
    Brief history e.g. MDMA patented by Merck then basically forgotten, Shulgin synths it out of interest in its similarity with MDA. The Texas crew, then Ibiza, the Euros getting into it in a big way, link to rave culture, etc. Talk about current situation.

    A chance for the ADD crew to go crazy. Use pictures!

    You wouldn't necessarily include this - possibly for drugs like crack where you have to put some effort into making them. You can include e.g. preparing ketamine powder from liquid, making crack from coke, etc. DO NOT include anything relating to synthesis! We're talking about taking a pre-existing drug and altering its form to make it easier/better to use, NOT making a drug from other chemicals.

    Mechanism of Action
    More ADD stuff, talk about neurotransmitters and GABA and SERT receptors and stuff.

    Trip Reports!?
    Erowid and Wikipedia for a start. Anything else that might be relevant.
    Last edited by Tommyboy; 04-12-2011 at 22:08. Reason: Added Trip Reports Links
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    Bluelight Crew animal_cookie's Avatar
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    Nov 2002
    thanks tommyboy
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    Bluelight Crew Tommyboy's Avatar
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    Dec 2009
    You're welcome.

    Mostly all of this applies to the Buprenorphine page as well, so I don't know we can either keep this as is, or make it more brief and put most this info in the Bupe page and have a link to it on the Suboxone page.
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    Bluelight Crew Tommyboy's Avatar
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    Dec 2009
    One of the things that may need to be edited is the ceiling dose of buprenorphine.
    I have it down as ~32mgs, which is the maximum dose prescribed, but there are other sources saying that the ceiling dose is a lot lower.
    If anyone else wants to weigh in on this feel free to.

    "Because of its ceiling effect and poor bioavailability, buprenorphine is safer in overdose than opioid full agonists. The maximal effects of buprenorphine appear to occur in the 16–32 mg dose range for sublingual tablets. Higher doses are unlikely to produce greater effects" (source).

    If anyone has the source that says the ceiling dose is between 2-4mg, please post it, as I was unable to find it right now, but have certainly seen it in the past.
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    I am currently detoxing off 16 mg of suboxone and my doctor prescribed me gabapentin and clonidine not..It seems to be helping some but not enough..last night I took a ativan for anxiety...shortly after I was hallucinating like crazy...any feedback will help
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    Suboxone (All buprenorphine products) are a bit of a contradiction if you ask me but they have saved my life I can safely say. Knowing a bill was passed for more doctors to have an unlimited amount of patients is what makes me sick to my stomach. Once someone has taken the medicine over two weeks they will consequently have worse w/d's with longer duration and not to mention the PAWS. Pros and Cons to the medicine but it can be used correctly and people with a strong mind set to stay clean from opiates if they can eliminate and cope with living as an addict to the end of their days. Here in the Ol' US of Aye!
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    I am currently withdrawing from this and it is not fun. I have no idea why my doctor would prescribe me a medicine like this and I was only taking vicodine for three months prior he should have just let me detox from that. This is the worse feeling ever. I am on day 7 with no meds and I still feel like I am in hell. I am ready to go to emergency.
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    Greenlighter tabbycat65's Avatar
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    Feb 2015
    Sparks and works great if you are really trying to get off of opiates one of the things that suboxin is supposed to do is make you sick to your stomach if you take opiates while you're taking them. You shouldn't never try to get high off of Suboxone it's a very dangerous substance but only be dangerous if you take it more than what you are prescribed I have a friend that was a very bad drug addict on opiates and she went to taking Suboxone to take about a year but she has been clean now for a very long time so I would suggest to anyone trying to get off of opiates to try to box and it works really well if used by prescribed hope this helps someone out there
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    Not always what it seems... 
    Quote Originally Posted by tabbycat65 View Post
    Sparks and works great if you are really trying to get off of opiates one of the things that suboxin is supposed to do is make you sick to your stomach if you take opiates while you're taking them. You shouldn't never try to get high off of Suboxone it's a very dangerous substance but only be dangerous if you take it more than what you are prescribed I have a friend that was a very bad drug addict on opiates and she went to taking Suboxone to take about a year but she has been clean now for a very long time so I would suggest to anyone trying to get off of opiates to try to box and it works really well if used by prescribed hope this helps someone out there
    First, I would say that it can be a wonder drug for many who have struggled with opiate abuse and can't seem to recover the natural order of things via traditional treatment programs. Honestly, I still felt zoned out and eager to chase when I was going to a methadone clinic. I kicked methadone cold turkey because I was just so ready to shake the side effects and the feeling of being in handcuffs and tied to a daily visit by a certain time. Other than the group meetings, I felt like I was part of a monetized herd of cattle (though I don't want to downplay the positive side of many H addicts and other related opiates using it as a stepping stone to climb their way out of that black hole.

    But the reason for the quote, there's a lot of misinformation about Subutex/Suboxone and just buprenorphine/buprenorphine+naloxone in general. Nothing I've read in research or even reviews suggests it's intended to cause discomfort if opiates are used while on a Sub regimen. The naloxone is only in Suboxone to discourage abuse or IV use. Though, they've indicated many times that buprenorphine has a higher affinity than the naloxone which is why overdose is tricky and requires supportive care as opposed to typical treatment with an antagonist like naloxone or naltrexone.

    It's very well known that order is everything with sub. You can take it before another opiate, assuming enough time had passed with little issue, though it's quite subjective and each person is different as to when the effects would be felt (there are benchmarks and respective timelines for general guidance). However, could you take a full opiate and then attempt the cold road of taking sub far too soon, you're in for a twisted ride of precipitated withdrawal during which you may very well wish you'd never seen an opiate in your life as the pleasant feel good is ripped off of your receptors in place of buprenorphine. Most everyone on it or around it knows someone who's made this mistake (usually one time is enough to never do it ever again).

    Lastly, it's not a silver bullet, and post maintenance, it has serious cons. But it's helped a lot of people find stability and get their life back. That seems like a pipe dream when you're in that dark place many of us reached. Kicking the sub is hard as well. But I can't compare it to full agonists that left me in torturous, unrelenting despair. I would urge anyone considering sub/bup maintenance to do your research and try to avoid prolonging your time in the program, seek out group therapy or something similar that fits for you, and go into the maintenance with a firm goal. Otherwise you end up on it for seven years like me. Regardless, I've been sub free and completely clean a year now. I wouldn't be alive without the program and the growth I experienced personally from it. For what it's worth, it can work if you want it to. But it's not a walk in the park. Just beware of the horror stories and the "it'll turn you into a corpse if you turn it sideways and say its name twice!!" type statements. All the best
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    between a rock and a hard place
    There is a lot to be said for suboxone as a maintenance drug. Monthly supply as opposed to the daily grind of mmt. I personally believe it saved my life &when combined with a 12step program, cbt and/or counseling can help the addict recover.
    I also don't believe anyone should be prescribed subs for a 3 month norco habit.
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    DO you have to do inpatient treatment to get put on suboxone as I have worked in a duel diagnosis treatment facility previously.
    I know it would probably benefit me but is it an option?
    As this is my first time posting maybe someone can inbox me
    Last edited by DannyGirl; 09-01-2017 at 04:08.
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    Quick corrections and some experience add.ons :/ 
    So buprenorphine is a synthetic opioid and partial antagonist to your dopimine receptors and Naloxone is just about the same thing almost I'll be quick subutex has just buprenorphine and it fills Ur receptors and kicks everything else out Ur sick as H Dying punching Ur own legs and Ur brain chem of dopamine is about @30% u IV a sub or a subutex at any amount Ur will really fing regret it from personal stories form my friend swim ive heard of someone waiting 54 hours ivd a text and had to be restrained from hallucinations but after the first couple of does subtounge Ur all good expecally if u keep it does at like a 4th of one 8milli or a half but all roa and boa lvls are about the same feeling lvl just hit u wicker then the other it's pointless and my bud has no veins anymore and can't shoot anything anymore.... neither can his docs got stuck 39 times before they just used a scalpel for a minor iv and ended up in a horrible hospital were his roomy sold herion and he relapsed in thirteen minutes...he's done everything in excess everything not bracing just fact now coming up on 5 years clean cept mjuana and booze won't touch a needle even if he could. Now at 24 he wonders if he'll see thirty u need info swim no's it lmk one love be safe.dont get caught as my dad.says
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    Bluelighter LopLover's Avatar
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    Sep 2017
    the beautiful Pacific NW
    Tommyboy, For me the ceiling hit around 8 mg. I've heard that it isn't the same for everyone. I've been on Sub for about 10 years, mostly at 2 mg and less, as I've been tapering very slowly. I'm still in the process of tapering, but am posting about that in the Sober Living thread. A couple of updates to the original post: Film strips now come in 2, 4, 8, and 12 mg sizes. I think that Reckitt-Bensicker--or whoever now owns the patent--is pretty secure about the future of their drug and willing to spend more money on R & D, since they know it's going to stay on the market and increase share for quite some time to come. I've been following the pharmaceutical companies for many years, and know how they operate. It's all about the all-important profitable patent. Sub is now off-patent, at least in pill form, but the strips, especially in the newer sizes, probably still are protected. That makes all the difference in the profitability of any drug.

    As for the naloxone, what I've been told is that it isn't bioavailable sublingually or orally, and is only added to stop people from injecting it IV; that it's very bioavailable through that route and is supposed to kick in and put an addict into withdrawals if they shoot the strips. I've never done it--got off the needle for good some years ago and at least stayed clean from that, after decades of IV use--but have heard enough experiences from other people that apparently the naloxone doesn't stop people from IV use. So I don't know about that. It is what the original material I got from the company said, though.

    Thanks much for the great information, BTW! I would add one piece of advice for anyone currently deciding whether to go on Suboxone (or methadone, for that matter) The info kinda downplays the dependency that they do cause, and, since both are so long-acting in the body, the length of time a taper takes, and the possible severity of the withdrawal symptoms even with a very slow taper. I began at 20, but dropped to 8 immediately, then to 4 just as fast. I've tapered steadily from 4 to my current tiny dose over the past three or four years.

    My reasons for staying on Sub for so long are long and complicated and already in the Sober Living thread. In a nutshell, I live in chronic pain from spinal problems, and have end-stage emphysema that prevents me from having the surgery that is the only treatment. I'm also retired on disability, and 64. I eventually got down to an extremely low dose, 1 mg per week, split into every other day like 1/4 or 1/3 mg. It's not enough to hold me, and I am deciding whether to finish the taper and grit my teeth for the w/d, which seems never-ending, or find a new doctor or clinic. The problem is that my doc, whom I love and trust--been with him 10 years--is retiring. Actually, he already retired, but has continued seeing me on a private pay situation--he's also my psychiatrist--but wants to quit fully by May.

    I want to warn others, particularly younger, healthier people who are addicted to pain pills or even heroin that going on a maintenance drug like Sub or methadone is a decision that will affect your life, maybe for years to come. Don't make it lightly. Other opiates, even heroin, can be kicked safely--though painfully--in 3 to 5 days. A Suboxone--or even methadone, the worst in terms of time sick--detox is usually 30 days, and isn't too awful for most people. But if you choose maintenance with either drug, and there are plenty of reasons to do so--for some people it's by far the smartest choice--you are signing up for something that is going to affect your life probably for at least a couple of years, and maybe the rest of your life.

    Sub is different for everyone. Some people jump off fairly high doses and seem to go on with their lives. Others are like me, and between the pain that is a part of my life, no matter what, and the depressing fact that the withdrawals never seem to end--the longest I've gone without getting some opiate to stop them is about ten days, so I know they last that long anyway--make simply staying on Sub the rest of my life look better and better every day.

    I won't go into the downside of that decision, but believe me, it has one as well. I just want younger people to know, especially since it's being prescribed so loosely right now--gee, just like OxyContin was a couple of years ago, eh?--that it may not be the life-saver they tell you it's going to be. It may be, though, for you--I can't make anyone's decision. I only want everyone to have enough information. Doctors and drug companies aren't driven by doing the best thing for you. Mostly they are driven by profit, unfortunately, and when you're sitting in their office or their treatment center or wherever, that is something you need to know so that you can make the best decision for yourself.
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    Quote Originally Posted by Tommyboy View Post
    The wiki currently just has a page for either buprenorphine or naloxone, but I think that there are so many people asking about suboxone on BL, that it should have it's own page. This is also because people often ask if the naloxone is active in suboxone, or if it will put you in precipitated withdrawals if you IV it. Therefore, I will start this page, and see if others can contribute if I run out of steam.
    As a Bentley compound, buprenorphine is not antagonised by naloxone unless it is administered in continuous infusion (or so a researcher with knowledge in opiates informed me). Buprenorphine belongs in the same class as etorphine and other veterinary tranquilisers; the only reason it is available for human use is its ceiling respiratory effect, which essentially means a first time user will be high as a kite from 24mg and will probably be dry heaving... but won't die. The specific antidote for etorphine/buprenorphine/Bentley compounds is diprenorphine. This is known as Revivon but is not a well-known agent; it can be given as a single shot, but apparently, Revivon has partial-mu-agonistic effect profiles... so you're trading one partial agonist (although a Bentley compound) for another.

    In street talk: mainlining bupe/nx will get you high and is used as such in British prisons. Sure, it won't have the initial kick, which WILL be antagonised... but it'll still "come back" in a bit.
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    What about jratom to help w/d fro subs !
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    I’m new and need help on where to post. My wife is on suboxone and take clonazepam, Dextroamphetamine-Amphet Er, Butalbital-Acetaminophen-Ca, and Methylprednisolone! She says her doctor is the one who prescribed her all these pills and is okay knowing her addiction issues. I’m not okay with it but she refuses to stop because she doesn’t think it’s a problem.
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    I am a chronic pain pt. was taking methadone 10mg with oxycodone 5 mg 4 times a day for 3 years and was switched to suboxone Friday as my insurance company was requiring new paperwork/records which they did receive and re-approved me for continuation on my normal course. My dr. suggested I try the suboxone and I am really regretting it. I had my 1st dose yesterday at 9am of the 8mg. I was a zombie all day yesterday with NO pain control. I took a 4 mg. this am thinking maybe it was just too much and feeling maybe the pain was withdrawl from my other meds, but not possible as I had to go into a precipated withdrawl to start this med. I am not going to continue the suboxone as i do not see any pain benefit other than very mild. Thw suboxone makes me unable to function. I haven't gotten anything done in 2 days. I'm going to resume my old course of medication with the oxy and methadone and flexeril at 8pm tonigh to see what happens. Hopfully, I will get some pain relief!!! Will post another message tonight and let you all know if my meds are kicking in at all. I feel suboxone is probably fine with 1 or 2 mild conditions, but it's definitely not strong enough to allow full function for those with severe issues.
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