When to resume suboxone?

[Wyborowa]

So swim finished swim's 2 week H binge. Swim did 4 bags at 7:30 this cold wednesday morning, the rest of swims stash. When should swim return to swims suboxone maintenence? Tomorrow morning? Tonight before bedtime? When swim gets the shits?

Last time swim waited until the next morning when Swim was clearly sick. Swim took suboxone and for about 2 hours felt horrible withdrawl symptoms then swim was fine... Should swim take suboxone tonight RIGHT before bed so in the morning the opiates are gone in his brain and then take suboxone again when he gets up?

Swim thanks in advance. H is the devil's liquid and can't believe how much swim blew in 2 weeks time. Swim wants the transition back to suboxone as smoothly as possible....Thanks again....

[Forthesevenlakes]

Wait until the first sign of withdrawals set in to start the suboxone if SWIY wants to figure out the proper dose. However SWIY's method of taking some before bed should work too. Keep in mind that suboxone has a long half-life, the dose when SWIY gets up is probably unneccessary. Suboxone lasts usually 24-36 hours, so SWIY could probably take it once a day and be fine.

Was SWIY taking the suboxone sublingually? Because 2 hours seems like a long onset time for a drug thats usually dissolved in the mouth.

[Wyborowa]

Originally Posted by Forthesevenlakes

Wait until the first sign of withdrawals set in to start the suboxone if SWIY wants to figure out the proper dose. However SWIY's method of taking some before bed should work too. Keep in mind that suboxone has a long half-life, the dose when SWIY gets up is probably unneccessary. Suboxone lasts usually 24-36 hours, so SWIY could probably take it once a day and be fine.

Was SWIY taking the suboxone sublingually? Because 2 hours seems like a long onset time for a drug thats usually dissolved in the mouth.

Oh god, swim found out last night wat a mistake that was. Swim took 2 subs at 6pm. Swim takes them rectally, seems to get the most out of it. So swim plugged them at 6pm......and hell broke loose at 6:30-45ish. Swim ran to the bathroom, never had soooo much diarehea, had the most intense burning withdrawl symptoms. Swim stayed on the jon for 30 min. in total complete OBLIVIOUS PAIN!! Swims anus would not close, meaning swim couldn't squeeze his sphincter , it just stayed open and hurt more when swim tried to squeeze it. Swim was slamming his fist on his thigh, the wall, thank god no one was home. Then after 30 min. swim felt bearable enough to lay in bed...

Now today, swim woke up at 7am for college. Swim felt..OK, then and hour later, felt the withdrawls. So swim got his script of subs for the month. then at 9am, siwm plugged 16mgs. Felt alright during school. Swim got out at 2, and had killer back pain, so at 2, swim plugged another 8mgs, then at 4, swim noticed swim's eyes were huge like i was rollin. so swim took ANOTHER 8mgs. Right now 45 minutes later, swims eyes still huge (for some odd reason just seeing swims eyes large gets his heart raciing just because swim knows there's not enough opiates in his system to be comfortable) Swim still has killer back pain...

Fuck that 2 weeks binge, spent enough loot. And the ending is never good. Thank GOD swim is prescribed subs.

So what do u guys think about what i did? What mistakes? How long till it takes for me to feel completely normal usuing my subs? Swim plans on taking 16mgs the next 2 days then resume to taking 1 a day...Man, swim was clean for so long...8 months...don't know how swim's gonna confront swims parents after seeing how much money swim took out the past 2 weeks....saying swim relapsed...fuck fuck....life's a bitch, eh?

and last questions is what can swim do now to make him feel more fucking comfortable?

Thanks fellow opiate/heroin users.

[Forthesevenlakes]

Originally Posted by Wyborowa

Oh god, swim found out last night wat a mistake that was. Swim took 2 subs at 6pm. Swim takes them rectally, seems to get the most out of it. So swim plugged them at 6pm......and hell broke loose at 6:30-45ish. Swim ran to the bathroom, never had soooo much diarehea, had the most intense burning withdrawl symptoms. Swim stayed on the jon for 30 min. in total complete OBLIVIOUS PAIN!! Swims anus would not close, meaning swim couldn't squeeze his sphincter , it just stayed open and hurt more when swim tried to squeeze it. Swim was slamming his fist on his thigh, the wall, thank god no one was home. Then after 30 min. swim felt bearable enough to lay in bed...

Now today, swim woke up at 7am for college. Swim felt..OK, then and hour later, felt the withdrawls. So swim got his script of subs for the month. then at 9am, siwm plugged 16mgs. Felt alright during school. Swim got out at 2, and had killer back pain, so at 2, swim plugged another 8mgs, then at 4, swim noticed swim's eyes were huge like i was rollin. so swim took ANOTHER 8mgs. Right now 45 minutes later, swims eyes still huge (for some odd reason just seeing swims eyes large gets his heart raciing just because swim knows there's not enough opiates in his system to be comfortable) Swim still has killer back pain...

Fuck that 2 weeks binge, spent enough loot. And the ending is never good. Thank GOD swim is prescribed subs.

So what do u guys think about what i did? What mistakes? How long till it takes for me to feel completely normal usuing my subs? Swim plans on taking 16mgs the next 2 days then resume to taking 1 a day...Man, swim was clean for so long...8 months...don't know how swim's gonna confront swims parents after seeing how much money swim took out the past 2 weeks....saying swim relapsed...fuck fuck....life's a bitch, eh?

and last questions is what can swim do now to make him feel more fucking comfortable?

Thanks fellow opiate/heroin users.

Hm, the first mistake was probably taking the suboxone rectally, when SWIY was not yet withdrawing. The naloxone in suboxone normally does not cross out of the stomach when pills are taken orally, but if the pill is taken via another route, the naloxone can get to the brain. The naloxone probably did just this, and took over the opiate receptors from the heroin still in SWIY's system, thus precipitating withdrawal.

The plugging could be why SWIY keeps getting back pain...naloxone is not supposed to compete with buprenorphine for opioid receptors, but it almost sounds like its partially effecting the efficacy of the pills to fight the withdrawals. Try taking the pills orally and see if that helps.

Also as the heroin completely leaves SWIY's system it should get better. Although, it probably should be mostly if not all gone by now. Give it a couple days to start feeling mostly okay, if SWIY had gotten a huge tolerance, 16 mg might not be enough to tide SWIY over until his tolerance drops a bit.

But SWIMs advice is to attempt taking the suboxone orally for a couple days and see if that helps. Maybe try some ibuprofen for the back pain...is it like withdrawal pain? Or is it possible that the back pain has another cause, and is just really bad timing?

[Wyborowa]

Orrally u mean Sublingually, right? swim has been plugging for a while now...6 monnths? Never had probs. And yes, the lower back pain is deff from withdrawls, its distinctive. You think plugging them makes the naltrexone reach the brain first? Swim knows that the buprenorphine also blocks out the opiates, pusshes them out....naltrexone only in there so u can't snort them or shoot em

swims tolernce was 4 bags of decent east coast dope (from NYC) for 2 weeks...


btw....since swim took all these subs, it would be pointless to try to shoot dope tonight , right?

[Forthesevenlakes]

SWIM initially said sublingually, its true, but he is wondering if the pills are actually supposed to be taken orally instead, since naloxone can get into the blood if its taken sublingually, but probably not if its swallowed (by orally SWIM meant swallowing in the last post).

Its not so much a matter of what gets to the brain first, but that with the initial dose, the naloxone out-competed the heroin for receptors and SWIY got withdrawals that apparently the buprenorphine couldn't compensate for.

Buprenorphine will probably out-compete the heroin SWIY takes unless SWIY takes a lot more H, and that probably is not a good idea. Plus with the naloxone in there, SWIY runs the risk of getting a weird interaction, maybe even more withdrawals. SWIM can't really predict whats going to happen since his firsthand experience is with buprenorphine alone (subutex), but it probably won't work, or it will be unpleasant. Stay away from the dope for the time being!

[Wehr]

Originally Posted by Forthesevenlakes

SWIM initially said sublingually, its true, but he is wondering if the pills are actually supposed to be taken orally instead, since naloxone can get into the blood if its taken sublingually, but probably not if its swallowed (by orally SWIM meant swallowing in the last post).

Its not so much a matter of what gets to the brain first, but that with the initial dose, the naloxone out-competed the heroin for receptors and SWIY got withdrawals that apparently the buprenorphine couldn't compensate for.

Buprenorphine will probably out-compete the heroin SWIY takes unless SWIY takes a lot more H, and that probably is not a good idea. Plus with the naloxone in there, SWIY runs the risk of getting a weird interaction, maybe even more withdrawals. SWIM can't really predict whats going to happen since his firsthand experience is with buprenorphine alone (subutex), but it probably won't work, or it will be unpleasant. Stay away from the dope for the time being!

It's swims understanding that simply swallowing the suboxone (taking orally) would destroy the bupe via the stomachs acid and thus making them ineffective. That's why they are supposed to be taken sublingually. Could be wrong though.

[Sib]

You need to be in moderate withdrawals before starting sub, if you take it too soon you will be sick. Here's the COWS scale; it will help you to more objectively figure out where you are with your withdrawals.


Resting Pulse Rate: (record beats per minute)
Measured after sitting or lying for one minute

0 pulse rate 80 or below

1 pulse rate 81-100

2 pulse rate 101-120

4 pulse rate greater than 120

Sweating: over past ½ hour not accounted for by room temperature or patient activity.
0 no report of chills or flushing

1 subjective report of chills or flushing

2 flushed or observable moistness on face

3 beads of sweat on brow or face

4 sweat streaming off face

Restlessness Observation during assessment
0 able to sit still

1 reports difficulty sitting still, but is able to do so

3 frequent shifting or extraneous movements of legs/arms

5 Unable to sit still for more than a few seconds

Pupil size
0 pupils pinned or normal size for room light

1 pupils possibly larger than normal for room light

2 pupils moderately dilated

5 pupils so dilated that only the rim of the iris is visible

Bone or Joint aches If having pain previously, only the additional component attributed to opiates withdrawal is scored
0 not present

1 mild diffuse discomfort

2 severe diffuse aching of joints/ muscles

4 rubbing joints or muscles and is unable to sit still because of discomfort

Runny nose or tearing Not accounted for by cold symptoms or allergies
0 not present

1 nasal stuffiness or unusually moist eyes

2 nose running or tearing

4 nose constantly running or tears streaming down cheeks


GI Upset: over last ½ hour
0 no GI symptoms

1 stomach cramps

2 nausea or loose stool

3 vomiting or diarrhea

5 Multiple episodes of diarrhea or vomiting

Tremor observation of outstretched hands
0 No tremor

1 tremor can be felt, but not observed

2 slight tremor observable

4 gross tremor or muscle twitching

Yawning Observation during assessment
0 no yawning

1 yawning once or twice during assessment

2 yawning three or more times during assessment

4 yawning several times/minute

Anxiety or Irritability
0 none

1 reports increasing irritability or anxiousness

2 obviously irritable anxious

4 so irritable or anxious that participation in the assessment is difficult

Gooseflesh skin
0 skin is smooth

3 piloerrection of skin can be felt or hairs standing up on arms

5 prominent piloerrection



Total scores

Score:

5-12 = mild;

13-24 = moderate;

25-36 = moderately severe;

more than 36 = severe withdrawal

I'm guessing it will take 12-24 hours for you to be in moderate WD's but you really need to go by the COWS scale rather than the clock.

I'd start at 2 mg every 12 hours. If you take the 2 mgs and do not feel any better after 90 mins, you can always take an additional 1-2 mg. You don't want to be looking for a high, you're looking to get rid of the WD symptoms. After 2 weeks on sub, the oxys will be out of your system and you should not have WD's from them, but you will likely feel some WD's from the sub once you stop. But the less sub you are on and the sooner you're able to get off of it, the less WD's you will have. Short term sub WD's are not nearly as bad as oxy WD's, but they're still there... just don't want you to be surprised (like I was!)






Sib added 10 Minutes and 0 Seconds later...

32 mg dose is a joke and addictive behaviour, remember less is more as far as sub is concerned.

Reputation Comments on this post:

Excellent post - informative, safety conscious & realistic

[Micklemouse]

Subs are prescribed sublingually. Should be taken either 4 hours after last use of other opiates or when cravings appear. There is a possibility that the back pains were related to the gastro-intestinal tract finally sorting it's shit out (pun very much intended this time!). The other, more probable, possibility is that SWiW had enough H still in their system to bring on the antagonist effect in full force. Subutex is only recommended for users with a moderate intake - 4 bags in a sitting aint exactly moderate! - some tapering is recommended before starting it otherwise there is a high chance of the antagonist effects ripping any remaining opiates from the brain, forcing withdrawal symptoms to appear.

Stick to the Subs, as prescribed. At least the bowel problems are over though...

[Wyborowa]

Originally Posted by Micklemouse

Subs are prescribed sublingually. Should be taken either 4 hours after last use of other opiates or when cravings appear. There is a possibility that the back pains were related to the gastro-intestinal tract finally sorting it's shit out (pun very much intended this time!). The other, more probable, possibility is that SWiW had enough H still in their system to bring on the antagonist effect in full force. Subutex is only recommended for users with a moderate intake - 4 bags in a sitting aint exactly moderate! - some tapering is recommended before starting it otherwise there is a high chance of the antagonist effects ripping any remaining opiates from the brain, forcing withdrawal symptoms to appear.

Stick to the Subs, as prescribed. At least the bowel problems are over though...

So can you explain why swim has large ass pupils when swim took a total of 32mg of suboxone today? 16mg in morning, 8mg at 1:30, 8mg at 4

[Micklemouse]

Dilated pupils are a sign of withdrawal - if SWiW had ever done a rehab or hospital detox this would be one of the things the nursing staff would be looking for in assessing the withdrawal, along with abdominal pain, goose bumps, runny nose, diarrhoea, agitation, etc. Given the amount of H SWiW took as a last dose, the chances are that the antogonist properties outweighed the agonist. It'll pass. Also, isn't 32 mg/24 hours a bit of a high dose to be starting on? In Briton it is started at 0.8 - 4mg/24 hours, max dose 32 mg after titration.

Side Effects:
Side effects of buprenorphine are similar to those of other opioids and include nausea, vomiting, and constipation. Buprenorphine can expedite opioid withdrawal with symptoms including, but not limited to: depression, nausea or vomiting, muscle aches and cramps, runny eyes and nose, dilated pupils, sweating, diarrhea, yawning, low fever, insomnia, cravings, and irritability.
Source: http://www.buprenorphine.samhsa.gov/about.html

[Wyborowa]

Originally Posted by Micklemouse

Dilated pupils are a sign of withdrawal - if SWiW had ever done a rehab or hospital detox this would be one of the things the nursing staff would be looking for in assessing the withdrawal, along with abdominal pain, goose bumps, runny nose, diarrhoea, agitation, etc. Given the amount of H SWiW took as a last dose, the chances are that the antogonist properties outweighed the agonist. It'll pass. Also, isn't 32 mg/24 hours a bit of a high dose to be starting on? In Briton it is started at 0.8 - 4mg/24 hours, max dose 32 mg after titration.

swim only has the dialated pupils, maybe slighjlty irritable....other than that hes fine! Just not comfortable...... u think swim took too much and it blocked it self?

[Forthesevenlakes]

32 mg/day is a pretty high starting dose, SWIM has seen starting doses this high but it was administered by a pain management specialist, for a patient who was using 15 mg fentanyl transdermal and 800 mcg fentanyl sublingual a day...so the doses can definitely get pretty large, but SWIM wouldnt reccomend someone trying this on their own without medical supervision.

[Forthesevenlakes]

It might have blocked itself, SWIM hasnt heard of that happening before but buprenorphine is a weird drug, a combination agonist/antagonist. Did the back pain go away? SWIM would probably use 16 mg max a day for a couple days and see how that goes.

[anabolictrio]

subutex is strange. His effect is not in direct ratio with dosage.
Normally 8mg are equivalent to 60ml of methadone. But luckily for swiy 32 mg are not equivalent to 240ml of methadone otherwise swiy wouldn't be here to tell us this experience.

Normally swiy should start to take it when swiy are already experiencing withdrawal sympthoms. Swiy should start with a really low dose such as 4mg wait 20 minutes and then eventually take another 2 mg.
That's how swim did...

[imyourlittlebare]

swim is on this as well. suboxone is a partial competative agonist/antagonist. this means. if you have any opiates in your system, they will be kicked out abruptly. health care professionals have you abstain from opiates 24 hours before taking suboxone. then you take, and your still sick a bit but not bad. once this period is over, you only have better to feel. once the suboxone takes over. but like i said, if you use any opiates or have any, they get kicked out and you are sick. also, there is a ceiling effect of sub. i believe its upto 50 mg but since swsims doc said take no more than 32 mgs a day then i think thats it. id assume its different for all. good luck. sub is a god send when you stay on it like your supposed to but shitty when you have a slip. everyone thinks its this wonderful medicine thats a crutch for people when they dont understand its a wonderful help for recovery or maintainance since i believe ill never recover.

[gramstel]

your problem was that 1) you took them up your butt 2) you have to wait 18 hours after your last use or the bupe will put u into terrible withdrawl

[dna_1977]

Originally Posted by gramstel

your problem was that 1) you took them up your butt 2) you have to wait 18 hours after your last use or the bupe will put u into terrible withdrawl

Hey guys,

Swim's experience tells him that waiting 12 hours after last opiate ingestion is enough (as long as wd symptoms are already being felt), 18 hurs are not necessarily needed; in swim's case anyway, to wait that long - 18 hours - would be quite unbearable since swim would by then be into full blown wd...

Swim knows different swimmers have different experiences and opinions about this subject: some say they have to wait something like 18 to 24 hours otherwise they'll fall into precipitated wd symptoms, other say even longer than that and still others say 10 to 12 hours are enough...

carpe diem

[xanned]

Just wait 12 hours.

Originally Posted by Wyborowa

So swim finished swim's 2 week H binge. Swim did 4 bags at 7:30 this cold wednesday morning, the rest of swims stash. When should swim return to swims suboxone maintenence? Tomorrow morning? Tonight before bedtime? When swim gets the shits?

Last time swim waited until the next morning when Swim was clearly sick. Swim took suboxone and for about 2 hours felt horrible withdrawl symptoms then swim was fine... Should swim take suboxone tonight RIGHT before bed so in the morning the opiates are gone in his brain and then take suboxone again when he gets up?

Swim thanks in advance. H is the devil's liquid and can't believe how much swim blew in 2 weeks time. Swim wants the transition back to suboxone as smoothly as possible....Thanks again....