I know I'm a bit late chiming into this thread but I suppose its never too late to add new information to new and undiscovered topics! I have personally been on the BuTrans 10 µg/hour patch for about 5 months now and for my condition, it's helped tremendously. Of course, my condition can be well controlled by even low doses of opioids
fortunately, due to both the nature of my condition, and my efforts to minimize tolerance over the years.
I have very severe, refractory, idiopathic Restless Leg Syndrome. I've tried over a dozen other medications and drug
classes, both typical for RLS and atypical, and the only class that's ever made a difference are the opioids. As bizarre as it may sound, it actually isn't unheard of for a person to be treated long term with an opioid
solely for RLS, and there's much research going on at the moment (some of which I've been part of) implicating an endogenous opioid-related component to the pathogenesis of the disease. Let me emphasize that my case of Restless Leg Syndrome developed spontaneously before ever using an opioid, however it's undoubtedly of equal intensity to the RLS experienced by opioid-dependent persons in the midst of abstinence, which as quite often mentioned as the worst symptom of withdrawal
I certainly know what taking an opioid recreationally is all about, but I've taken great care to remain equipped and educated over the years in such a fashion that I minimize my susceptibility to tolerance so that opioids continue to remain effective throughout my lifetime. I've come to appreciate the drugs
for the relief they provide, which has resulted in more responsible use. I was on hydrocodone
prior to the BuTrans and requested the BuTrans myself for it's higher potency (in regards to analgesia) and especially for its uniquely superior pharmacology in terms of tolerance development, long half-life
, ease of availability (CIII), and the convenience of a 7-day transdermal patch.
So enough about me, and more to the information I have to offer and the questions I have specifically about BuTrans: I switched from 7.5 mg of hydrocodone 3 x a day to BuTrans because trying to maintain pain/discomfort relief from RLS with an 8 hour dosing schedule with a short acting drug like hydrocodone (my Dr. preferred to keep it to 8 hours) was just not adequate and the acetaminophen
was unnecessary. I began on the 5 µg/hour patch but my metabolism is too rapid so as soon as I'd begin getting relief, I'd burn off the buprenorphine
before the patch could accumulate sufficient levels in my blood to maintain relief so my relief was not consistent. I requested to move up to the 10 µg/hour patch and ever since, I've maintained consistent control and relief of RLS symptoms. As far as subjective effects go, I definitely do notice a mild opioid-like effect, somewhere between the intensity of hydrocodone and morphine
, although just...different, and it remains pretty constant, although because it's so constant, I become so accustomed to the feeling throughout the week that I can hardly distinguish it from normality until it starts wearing off and I apply a new patch lol. I also have zero experience with buprenorphine prior to the BuTrans so I don't have a good standard of what to expect and look for in terms of euphoria
. I will say however that I have taken an old patch removed after the 7th day, and placed it in my mouth, such that the medicated side was touching my gums and my cheek. My intention of doing this was to continue using left-over medication for relief beyond 7 days so I could accumulate spare patches in the event of a vacation, theft, or a judgmental pharmacist lol. Doing this definitely resulted in an INTENSE rush of opioidergic activity, unlike any other opioid I've really ever tried. Not necessarily the best by any means, but just different. It was also very sedating and had me nodding off throughout the day, even from just letting it absorb inside my mouth for only 15 minutes (long half-life!). Obviously the extra heat inside of the mouth and the increased bioavailability of the buccal region and blood vessels of the sublingual mucosa compared to transdermal bioavailability were to blame (or thank lol) for the increased intensity in effect. However, this process also has instigated a question amongst my inquisitive, resourceful way of thinking....
I read on the patch packaging the other day that each 10mcg/hour patch contains a total of 10 mg (that's MILIgrams, not micro!). How the hell is this the case? If the patch itself is rated to release 10 MICROgrams per hour, that would result in 240 MICROgrams (or .24 MILIgrams) per day that accumulate (which isn't hard to accept given the long half-life of buprenorphine), (I figure this by multiplying 24 daily hours by the 10mcg released per hour). If you extend that to the full 7 days that the patch is intended to be worn and released, then (multiplying the 240 MICROgrams by 7) you get a total of 1,680 MICROgrams, or 1.68 MILIgrams. If a total of only 1.68 MILIgrams are released in 7 days, then why in the hell would they put 10 entire MILIgrams in a single patch, over 8 extra mg than necessary?? Is there something that I don't understand about transdermal delivery
that I've failed to take into account here or what? Is the rated 10 mcg/hour regarding the actual amount that reaches the bloodstream, and not just the amount released from the patch into the skin? On that same note, for the drug to reach the bloodstream in significant quantities, does a much larger amount of the drug have to be dumped into and saturate the dermis before smaller amounts can get through to the bloodstream? What am I missing??!! And thus, if there are an extra 8.32 mg in the patch when I remove it, how can I take advantage of it instead of letting it go to waste? I believe that I'm at least somewhat putting it to use when I use it buccally, but could the patch be worn for longer? I guess I should experiment!
Based on this logic, a single patch could be worn for an entire month before running out of medication.
Someone, anyone, share your thoughts, feelings, and ideas, please!
thair7391 added 34 Minutes and 20 Seconds later...
Originally Posted by toxinreleased
I'm trying to get to as small a dose of pain meds as possible. BuTrans seems like a logical choice for the next step down, as it is roughly 1/2 as strong as Fentanyl
, and it should, being Bupe, help with some of the absolutely horrible WD's that you get from Fentanyl. Currently, I'm down to 25 mcg/hr fentanyl and I was thinking about dropping down to 12.5 (which is the lowest dose patch available, I believe), staying there for 30 days (I drop by 25 mcg/hr every 30 days), and then jumping to a 20 mcg/hr BuTrans patch
. At that point, I can further reduce to 10, and finally to 5, if necessary, and then jump off that and go on (probably) oxymorphone
/oxycodone combination. That's IF I can get that low again without being a total cripple! Otherwise< I might just stay on the BuTrans patch for keeps. Plus, the BuTrans patch is good for 7 days, instead of just 3, like the Fentanyl is.
One of my concerns was meds for the break-thru pain or pain that occurs before the patch has reached full effectiveness. Again, because it is Bupe, how does that work? Being an antagonist/agonist combination, wouldn't it
prevent other opiates
from working? I was also thinking about having my doctor prescribe Subutex
for a couple of days, just to get it built up in my system and "jump-start" the process, until the patch has a chance to become fully effective. Then, I can pull the oral meds and just stay with the patch. 3 or 4 days of two to four mg pills should be enough, I would think.
Still, I would like to hear from others on this, If you are out there! Any info on these patches or on my proposed methods would be appreciated.
Having been on the BuTrans 10 µg/hour patch myself for several months now, I can confirm that (on this dose at least) taking another full agonist in combination with the patch will still work with at least 80% effectiveness, if not complete effectiveness, even with a weaker agonist like hydrocodone which I have indeed tried. With the 10 µg/hour patch, and assuming a 24-hour half life of buprenorphine for convenience sake, you're getting an accumulated dose of .240 mg of buprenorphine per day, the equivalent of one-eighth of a 2 mg Suboxone
tablet. I don't have any experience with buprenorphine apart from BuTrans (used therapeutically), but everything I've ever read, both in medical journals and personal experience, suggests that in doses less than 1 mg of buprenorphine (even less than 2 mg in some places), the blockade effect is not significant enough to prevent the additive effectiveness of concomitant opioid agonists. I don't know if you're familiar with Dr. Jeffrey T. Junig and his work and experiences, but he's been pushing and publishing the use of buprenorphine combined with typical agonists in chronic pain management to prevent development of tolerance and psychological dependency to opioids. He says that the dose of buprenorphine must be at least 2 mg to block the rewarding effects, however, even in his trials at this dose of buprenorphine, the analgesic effects of oxycodone
were not inhibited and in fact, were compounded. Obviously you probably don't want to prevent euphoria (nor would I), and I can confirm that at the low doses of BuTrans, euphoria is not inhibited, but I'm mentioning Dr. Junig's work because it shows that even at 2 mg of buprenorphine, other opioid agonists are still effective at relieving pain and would also, therefore, prevent any withdrawal symptoms so I don't think you'd have anything to worry about. I say just start the BuTrans at whatever dose you think would be necessary (I can personally vouch for the 10 mcg/hour to be much more effective than you probably expect) and maybe initially have some typical opioid agonists of your preference handy for potential breakthrough pain in the event that the BuTrans is not adequate, or if your tolerance is high enough, to prevent withdrawal. If you didn't read my previous post, you can also take the patch, cut the adhesive sides off (leaving only the medicated rectangle) and then fold it in half with the skin-side facing outward (of course lol) then place it in your gums so that one folded side is touching your gum, and the other touching the inside of your cheek. Doing this results in more rapid release of buprenorphine as well as more rapid bioavailability/absorption which I'm confident would rid you of any withdrawal symptoms that may occur and likely most pain. You also don't have to compromise the integrity of the transdermal system to do this. I will mention though that if you use a patch this way from the start of the patch instead of applying it to the skin, it will only last you about 4 days instead of 7 since the release of medication is more rapid and will unfortunately bring you up short of medication before your expected refill date :/