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Opiate addiction Support for coping with Opiate addiction and Opiate addiction treatment.

 
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  #1  
Old 19-02-2013, 02:32
will430 will430 is offline
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Going from fentanyl to suboxone

Ok, I read the wait times on most opiates when switching to suboxone. But fentanyl to me is a confusing one. I'm going from wearing a 75mcg patch for 3 days to suboxone. Now i've seen where fentanyl is a short half life and i understand that. But i need to know since i've worn the patches the correct way. How long does it take for fent to leave the body to properly take suboxone.

I've seen where it makes the fent deposit in the skin and is still releasing medicine in the body even after you take the patch off. There is alot of stories of people switching to sub from fent and going through PW's. Now, i do not want to be one of those people. Can someone show me the info as to a timeline when fent is done deposting into your body after taking a patch off. I can not think of a worst way to go into precipitated withdraws then going from fent to sub to early.

Please please do not just say "wait till your in withdraws Or use the COWS sheet. To me that should be common knowledge. : /

If i find this info out. I can multiply that half life of the fent from the time i take it off. To the proper wait time that i feel will be in sufficent withdraws. I want to run 0 risk of PW's aswell as minimal suffering to getting back to suboxone. Thanks for any stabs at this question. And anytime you put into answering.

Heres where i currently stand. Feb 18th at 9:00pm I took off my 75mcg patch. Now i need to know a time frame to work into when the best time it will be to take my subs. (Just got the prescription for 40 of em.)
  #2  
Old 19-02-2013, 02:40
ak2Ut ak2Ut is offline
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Re: Going from fentanyl to suboxone

Thats a tough one, i dont have experience with fentanyl but i do have experience taking sub to soon and dealing with the precipitated withdrawals, they are the worst.

I hope someone can answer your question
  #3  
Old 19-02-2013, 03:34
BitterSweet BitterSweet is offline
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Re: Going from fentanyl to suboxone

The mean elimination half life is 17 hours. I found some sources saying 7 hours, or the range of 9.5-12.4 hours, but the 17 hour information is from an official government produced document:
http://dailymed.nlm.nih.gov/dailymed...2-A417897EC24F

You seem to know most other stuff about getting off fentanyl and onto suboxone, that taking the suboxone too soon could make you pretty sick. It sounds like you also know to multiple that half-life by 6. So good luck.
  #4  
Old 19-02-2013, 04:42
D. Pendent D. Pendent is offline
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Re: Going from fentanyl to suboxone

I'm looking at a similar situation.
(And BTW, this my first post here at the forum, so I hope I'm not breaking the guidelines in any way. Since I'm not discussing anything illegal other than abusing my prescribed medication, I think I'm okay)
I've been on 50mcg patches for over two years now.
I have stenosis and spondylosis in my neck, which started in 1985 but it took literally 20 years to get ONE doctor to properly diagnose with an MRI- in all the time before that I was treated like it was all in my head, so they threw SSRIs at me. Around 2005 I finally got diagnosed and was promptly put on REAL pain medication, from Vicodin, to Norco, to Kadian/morphine, Percocet (though never Oxycontin- I've never even seen an Oxycontin! That's probably for the best) and finally I was put on the Fentanyl patch at a dosage of 50mcg every 48 hours (I am 47 years old and have always been very skinny and I think it's my high metabolism that makes it so the patches don't last three days like they're designed to.
So here I am on 50mcg patches with no adjustments to my dosage in over two years now, so as you might imagine my tolerance has gone up, and they don't work like they did in the beginning- They were incredible at first!!! Ain't that how it goes? (I'm in WDs as i type this, so I hope this all makes sense and isn't written too poorly! I'm doing my best.)

My pain management doc put me on them originally, and then after I was deemed "stable" they cut me loose and sent me to my regular M.D. to continue prescribing them.
That went on for 22 months, but little by little they began to work less and less and I found myself running out every month due to overlapping my patches (a new one every day and a half or so. Originally it was every two days, but then every other day and a half I would feel WDs so I started overlapping my dosing. This of course led to me running out early every month. Then I told my M.D. that I had been running out early for several months, and as i expected she has referred me back to pain management.
I am very curious to try Suboxone, or preferably Subutex (I don't intend to abuse my meds by injecting so why take the naltrexone at all? Some people have a bad reaction to it I've read, so I'd prefer to just keep it as simple as possible).
My P.M. doc said they are trying to get people to reduce or even eliminate the narcotic pain relievers entirely- the prospect of which frankly scares the sh*t out of me. On the other hand, I don't want my dosage increased either! That'll just eventually lead me to be more dependent and the WDs will also be worse.
So, I'm very interested in using Subutex, because at this point my addiction/dependence seems more of an issue than my pain is. (I've dealt with the pain since 1985).

My reasoning for wanting to try Suboxone is that it has less abuse potential (I believe) since it can only get you so "high" and then you hit a ceiling, so I would have less incentive to take more than prescribed, and therefore I wouldn't be running out every goddamned month- and that would make me more stable overall obviously. I'm also interested in the supposed anti-depressant effect (I am indeed depressed and had been on every stupid SSRI for the nearly 20 years before I got a proper diagnosis for my pain- which started my narcotic odyssey, and ended my SSRI nightmare! (SSRIs did little to nothing for me, and some made me f*cking suicidal!!! I am very anti-antidepressant!!!

I don't see my Pain Doc for another week, and I'm out of my patches, so I will be (more than) "clean" when I go in. He has not promised that I will even be given the Subutex- he just said it's a "possibility".

I have heard good and bad things about these "sub' drugs. Some say it's been a "Godsend" and given them back their lives and even helped their depression, while some have had bad reactions, and many seem to say it's really really hard to get off of it once you're on it.

I think every opiate is hard to kick, and whatever you're kicking seems like it's the worst at the time.
Now my PM doc hasn't said that he WILL put me on Subutex/Suboxone (Buprenorphine) only that it's "one possibility". I will keep you all posted on how things go- if they go at all.

Anyway, this is my first post here so I hope I'm within the guidelines and all that- Someone let me know if I'm not.

D. Pendent added 4 Minutes and 4 Seconds later...

ALSO- The elimination of Fentanyl is different for everyone- (Everything is different for everyone!) Things like how much body fat you have, how active you are, and other factors can cause different people to experience different half-life times.
Just throwing that in there.

Post Quality Evaluations:
excellent addition of personal experience

Last edited by D. Pendent; 19-02-2013 at 04:42. Reason: Automerged Doublepost
  #5  
Old 19-02-2013, 20:56
will430 will430 is offline
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Re: Going from fentanyl to suboxone

Wow dude, start your own topic. Don't try to crash mine!!!

Post Quality Evaluations:
Personal experience is a vital part of any thread. You do not "own" this thread.
This is an open forum & other posters have full right to empathize & share their experiences especially those so similar.
One would think that the answers he/she is getting will be relevant for you too, as you seem to be in the same boat. If it was raising another topic I could understand your frustration.
  #6  
Old 28-02-2013, 11:15
D. Pendent D. Pendent is offline
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Re: Going from fentanyl to suboxone

Quote:
Originally Posted by will430 View Post
Wow dude, start your own topic. Don't try to crash mine!!!
My bad, I guess.
This site advises looking for existing threads on the same subject- at least I thought they did.
Clearly, looking back, I had a sh*t ton on my mind when I posted, and as I said, it was my first post here. I didn't mean to jack your post!
My dumb-ass pain doc wants to wean me off the patch now after two and a half years on the 50mcgs. I told him I really wanted to try Buprenorphine, but he acted like it wasn't available- then as he's handing me my prescription for the fentanyl, I heard him instruct one of the nurses to take a patient into a room where he was going to give him his first dose of suboxone, and monitor him- So clearly he does prescribe the "bupe", but I just don't seem to qualify in some way.
Bummer.
Sorry again- I guess.
I thought the point was to pool our knowledge and experience.

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No need to be sorry, the purpose is to gather as many such stories in one thread, you have done nothing wrong.
  #7  
Old 28-02-2013, 16:13
St Dismas Novitiate St Dismas Novitiate is offline
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Re: Going from fentanyl to suboxone

Quote:
Originally Posted by D. Pendent View Post
My bad, I guess.
This site advises looking for existing threads on the same subject- at least I thought they did.
Clearly, looking back, I had a sh*t ton on my mind when I posted, and as I said, it was my first post here. I didn't mean to jack your post!
My dumb-ass pain doc wants to wean me off the patch now after two and a half years on the 50mcgs. I told him I really wanted to try Buprenorphine, but he acted like it wasn't available- then as he's handing me my prescription for the fentanyl, I heard him instruct one of the nurses to take a patient into a room where he was going to give him his first dose of suboxone, and monitor him- So clearly he does prescribe the "bupe", but I just don't seem to qualify in some way.
Bummer.
Sorry again- I guess.
I thought the point was to pool our knowledge and experience.
You are quite correct-the goal is to pool knowledge and resources. And regardless of what the OP may think, the addition of personal experience and knowledge makes an excellent addition to ANY thread, so continue what you are doing! The OP needs to learn that questions are answered in a variety of ways, and quite often, the addition of another members personal experience will lead to the requested information.

Plus, while we try to help everyone, it should also be understood that threads don't "belong" to anyone, or more correctly, they belong to everybody. While the OP may be the thread starter, they have no control over who may post there or what information is offered.

toxinreleased added 17 Minutes and 28 Seconds later...

Quote:
Originally Posted by will430 View Post
Ok, I read the wait times on most opiates when switching to suboxone. But fentanyl to me is a confusing one. I'm going from wearing a 75mcg patch for 3 days to suboxone. Now i've seen where fentanyl is a short half life and i understand that. But i need to know since i've worn the patches the correct way. How long does it take for fent to leave the body to properly take suboxone.

I've seen where it makes the fent deposit in the skin and is still releasing medicine in the body even after you take the patch off. There is alot of stories of people switching to sub from fent and going through PW's. Now, i do not want to be one of those people. Can someone show me the info as to a timeline when fent is done deposting into your body after taking a patch off. I can not think of a worst way to go into precipitated withdraws then going from fent to sub to early.

Please please do not just say "wait till your in withdraws Or use the COWS sheet. To me that should be common knowledge. : /

If i find this info out. I can multiply that half life of the fent from the time i take it off. To the proper wait time that i feel will be in sufficent withdraws. I want to run 0 risk of PW's aswell as minimal suffering to getting back to suboxone. Thanks for any stabs at this question. And anytime you put into answering.

Heres where i currently stand. Feb 18th at 9:00pm I took off my 75mcg patch. Now i need to know a time frame to work into when the best time it will be to take my subs. (Just got the prescription for 40 of em.)
Are the suboxone in sublingual tabs? I would assume that they are, but you did not mention it. You also did not mention the dose you were starting out with. I made the move from fent to buprenorphine with no problems at all. I was on 2 of the 100 mcg patches every 72 hours. I removed the last two patches, washed the area well with soap and water, and then scrubbed the area with rubbing alcohol. I then waited for 48 hours and started the first tab.

No problems, no precipitated withdrawals. Actually it is a misconception that you cannot take buprenorphine and other narcotic pain meds. The deciding factor will be the dosage of bupe that you are on. I use the bupe for chronic pain and oxycodone for breakthrough pain, and have never had an issue with either. However, I am on the 2 mg sublingual tabs and not the 8 mg ones. With 2 mg, you can continue to take other narcotic pain meds, but once you get past that, the full antagonistic effect of the bupe comes into play, with all of the associated issues.

In addition, fentanyl is one of the few drugs that can break the buprenorphine blockade on the receptors, so while bupe will "kick out" other opiate-based molecules, fentanyl is strong enough to kick out the bupe and break the blockade. I would not advise this however, because while it is possible, it is NOT comfortable!

So, If you are using a transdermal formulation of bupe, you can peel the fent, wait 24 hours, and apply the bupe. If you are using orally, I would wait for a minimum of 48 hours and ideally 72 from the time you peel the patch until the time you use the bupe. Obviously everyone is different, so be careful!

It should also be noted that the dosing for opiate withdrawal therapy will be different than the dosing for chronic pain. While I assume that you are using this for chronic pain, your post is not clear on that.

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Good info and follow-up questions.

Last edited by St Dismas Novitiate; 28-02-2013 at 21:57. Reason: Automerged Doublepost
  #8  
Old 28-02-2013, 18:23
Jumpbunny Jumpbunny is offline
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Re: Going from fentanyl to suboxone

Fentanyl is a full mu opioid agonist, and YOU WILL go into precipitated withdrawals if suboxone is taken too soon. Now, if lets say you were already taking suboxone for a bit and your dr wanted you to have extra pain relief on top of suboxone (bupe) then taking fentanyl AFTER being on suboxone isn't a problem. Just wanted you to realize the difference because a newbie to suboxone may misinterpret the last post. Ideally, look up the COWS (clinical opiate withdrawal scale) worksheet online and make sure your score is at least a 26. I know people who thought they waited long enough and had BAD precipitated wds. Always best to start suboxone, when you are in moderate to severe withdrawals, starting off with a low dose, around 2 mg, and wait. If you don't feel worse, it's ok to take more if needed (if you don't feel worse, that's a good indication that you aren't going into precipitated withdrawals). Anyways, good luck with your induction. Take care
  #9  
Old 02-03-2013, 07:53
will430 will430 is offline
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Re: Going from fentanyl to suboxone

Ok i took suboxone after 19 hours of removing that 75mcg gel patch (activia) and started with 0.5mg of sub. I was ok. 2 hours later took 4mg of subs. Thought i was having precipitated withdraws about 15min into it. Turns out it was only anxiety making me panic. I was fine. 19 hours off fent and no PW's. Odd. accroding to the half life of fentanyl being distributed in my skin. I should have suffered epic PW's. But i was fine. Went to work and everything that night. : )
  #10  
Old 02-03-2013, 13:22
St Dismas Novitiate St Dismas Novitiate is offline
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Re: Going from fentanyl to suboxone

While precipitated withdrawals are certainly no joke, I think that the likelihood of their occurring is smaller than most would think. I, too, practically worried myself sick trying to get all of the calculations just right and making sure I was already in withdrawal and all that other crap, and none of it really mattered. Fentanyl will blow buprenorphine right out of the brains receptors.
  #11  
Old 04-03-2013, 17:03
Crazymonkey11 Crazymonkey11 is offline
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Re: Going from fentanyl to suboxone

Hi there! I just went though a Detox at a facility for 7 days it was expensive but I trusted the staff to know what they were doing. Plus they promised a Painless withdraw....yeah right! You can read my journal if you like to see what I have been going though.
I was on 75 mcg fentanyl and Percocet 10 every 6 hrs. For 3 years.

When I arrived at the detox facility they had me remove my patches and they gave me a Subutex right then and there. Then another four hrs after, I woke that night soaked in sweat shaking, vomiting, it was not fun. I wonder if this was PWs I had never heard of PWs or knew of such a thing till reading it on this post. So my guess is that's what I went though the 1st nite there. Wouldn't you think the Dr or nurse would of waited to give me a sub? Makes me mad now just to think that they screwed up because they didn't know what they were doing.

Long story short...(again you can read my story if you want to know more) because its a long one! I went though 3 days of detox hell felt better around day 5 day 7 went home....just to detox at home even worse. Yeah I got my money's worth!
Since I have been home this detox has kicked my ass to say the least. It's been awful I still am going though it. I don't know what happened? Why did I detox twice? But I hope no one has to go though what I did. My guess is I rollercostered just to have to detox from the Subutex at home after only taking it for 5 days. I have been home now for 10 days and its been really tuff. Although everyday I get a bit better.

I don't know how typical it is for what happened to me to happen to you, I just want to make people aware of what I am going though because something went wrong somewhere. I don't know what maybe someone here mite know what it was.

Getting off the fentanyl was a good choice for me, I love not having to worry about how many patches I have left, or trying to remember when I put the last one on. Watching my arms to be sure the patch didn't come off. I wouldn't swim, or get sweaty even in the shower I was worried to get soap on that arm. Oh Thank God that worry is over. After being on the patch for so many years it feel funny to wash my arms and I am still carful putting things on and off haha. Also I don't ever have to go to the pain Mang Dr again I love that part the most.

Good luck to you know that your not alone at all. I support your dicison to get off the patches because they are a huge pain. Take care.
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Old 05-03-2013, 08:47
BitterSweet BitterSweet is offline
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Going from fentanyl to suboxone

No offense, but D. Pendant kind of did hijack the thread. He only talked about his situation and then made a reply with just an update on his situation. He didnt really answer the OP's question at all, nor did he attempt to link his story to empathize with the OP's similar opiate addiction.

D. Pendant, you would be better off to start your own thread with all that information because you will get a lot of support and advice, although it is your first post I bet you have a lot on your mind! Plus I know how it goes when you go to write one sentence down and you find yourself pouring your heart out.

I did find it funny in a cute way though, you innocently sharing your story then "dude, don't hijack my thread" lol. Just poking fun.
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Old 08-03-2013, 08:52
D. Pendent D. Pendent is offline
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Re: Going from fentanyl to suboxone

I really didn't have much in the way of info about 'bupe" so there wasn't much i could offer in the way of advice-
As it turns out, this thread has taken a turn that is in fact helpful for SWIM (No, really!).
They are being weaned off the Fentanyl, so their dose was cut by 1/4, From 50mcg, to a 25+12, so 37mcg) However, the pharmacy didn't have the 12's so their regimen is all screwed up- Now the 25's are gone and they were only able to fill part of the Rx for the 12's- thus they will run out before they see the doctor again for their next "weaning" Rx.
SWIM was able to secure a small amount of Suboxone, but they have no experience with it- so the info on this thread will be very useful for him/her.

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  #14  
Old 12-03-2013, 09:45
D. Pendent D. Pendent is offline
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Re: Going from fentanyl to suboxone

Quote:
Originally Posted by Crazymonkey11 View Post
When I arrived at the detox facility they had me remove my patches and they gave me a Subutex right then and there. Then another four hrs after, I woke that night soaked in sweat shaking, vomiting, it was not fun. I wonder if this was PWs I had never heard of PWs or knew of such a thing till reading it on this post. So my guess is that's what I went though the 1st nite there. Wouldn't you think the Dr or nurse would of waited to give me a sub? Makes me mad now just to think that they screwed up because they didn't know what they were doing.
.
WOW.
So glad you got through that and you sound very happy to be off the meds.
What were they thinking giving you a dose right as you removed the patch???
That is NOT how to administer buprenorphine! (God, I think I'd sue them! Well, I wouldn't but...)
It's pretty common knowledge that you have to be IN W.D.s before you take subutex/soboxone
or it will put you into major W.D.s!!! Irresponsible! I think you went through that W.D. then a second W.D. from their medication (and seven days is really fast- for someone on the amounts you were on!!)

I would expect others will agree with me. I'm not experienced with "bupe" but I have read a lot now, and that is a crazy treatment plan- IF it even qualifies as a plan.

Hope you're doing better.
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Old 01-05-2013, 01:25
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Re: Going from fentanyl to suboxone

Hi All...After searching many forums, I found this one to be the most informative for my situation, so here I am to share my story and maybe help others...I was hit by a car while riding my bicycle in August 2011...Since then I have had 6 surgeries and lots of hardware installed...For over a year and a half I was prescribed 100 mcgs fentanyl patches every 72 hours and 4mg dilaudid 4x a day for breakthrough pain. Since I did NOT want to be "handcuffed" to pain killers any longer, my Dr told me about Suboxone, and I chose to give it a try. I took my last patch off and took my last dilaudid at about 7:00pm...the night was OK, and I wanted to wait as long as possible the following day to begin the Sub...After about 20 hours, I was in full withdrawl, so I cut an 8mg Sub strip in half and took it, and within an hour the "withdrawl feeling" got better...I kept taking half strips of 8mg Subs every 2 hours, totaling two 8mg strips. By the next morning I had reached a "comfort level". I have been on the Subs for a full week now and continue taking 1/2 of an 8mg strip 4x a day and feeling OK. I'm thinking that by cutting the strips in half, and slowly introducing the Suboxone into my body, it's possible I avoided those nasty PW's I keep reading about. I dunno...I suppose everyone is different, but that "system" worked for me. Slow & steady won that race! Now my concerns are how long it may take to get off the Sub...Pain is a constant, but I am tolerating it with OTC pain meds. I'm frustrated because I hate the feeling of being "handcuffed" to any drug, and I hope I made the right decision by going on the Suboxone. Wishing you all well, and thanks for listening.

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