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Thread: Suboxone (buprenorphine/naloxone)

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    Suboxone (buprenorphine/naloxone) 
    #1
    Bluelight Crew Tommyboy's Avatar
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    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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    #2
    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.

    Effects
    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.

    Dosages

    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.
    Sublingual
    Nasal
    Intravenous
    Intramuscular
    Rectal


    Problems

    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
    [http://en.wikipedia.org/wiki/Buprenorphine]
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    #3
    Bluelight Crew Tommyboy's Avatar
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    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.

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

    Preparation
    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
    http://www.bluelight.ru/vb/threads/5...-Stimulating!?
    http://www.bluelight.ru/vb/threads/5...irst-Time-MOA?
    http://www.bluelight.ru/vb/threads/4...me-Experience?
    Links
    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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    #4
    Bluelight Crew animal_cookie's Avatar
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    thanks tommyboy
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    #5
    Bluelight Crew Tommyboy's Avatar
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    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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    #6
    Bluelight Crew Tommyboy's Avatar
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    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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    #7
    This is a new things for me guys..I was hoping I could throw out a question and maybe get some good insight from you
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    #8
    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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    #9
    Bluelighter Whosajiggawaaa's Avatar
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    GROSS> suboxone is GROSS!
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    #10
    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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    #11
    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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    #12
    Greenlighter tabbycat65's Avatar
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    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... 
    #13
    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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    #14
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    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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    #15
    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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    #16
    Do you absolutely have to do in patient treatment?
    Congratulations by the way
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    Suboxone 
    #17
    This is my first time posting and I'm not sure it's right.
    I have a few questions about Suboxone and really need some advice.
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