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Yes, it IS possible to go from Heroin straight to Subutex. However, what you need to consider is Why do you want to do this. Do you want to 'stabilise' on Subutex, or do you want to use Subutex as a 'step-down' method to detox. Either, or both, are possible.
Below, I have outlined briefly how Subutex works; then I have outlined the priinciples of how one would transfer from Heroin directly to Subutex. Subutex can then be used as a 'maintenance therapy', in a similar way to methadone maintenance; or as an effective and relatively stress-free means of detox, simply by reducing the dose incrementally. In detox-ing, some people find lofexidine helpful in reducing withdrawal side-effects. I would recommend seeking profesional help, as then the Subutex (+/- lofexidine, +/- adjunctive medications) would be prescribed, and a detox regime could be taylored to your needs. However, it is certainly possible to do it on your own.
How Subutex works:
Subutex (generic name buprenorphine)is a partial agonist/antagonist at the opiate receptor. That means, it attaches to the same receptor site in the brain and nervous system as does Heroin (and other opiates - morphine, DHC, DF's, codeine. However, there are some important differences in the way that Subutex affects the body, as opposed to Heroin:
1) It is a Partial antagonist. That means, it only has some of the affects that Heroin does. It does not give a great high, but it can make you feel good, and it will certainly stave off withdrawals.
Subutex does not have such a marked effect on the circulatory and respiratory system as Heroin does. Heroin causes heart-rate and breathing rate to slow down, even to stop, which is what happens in overdose. An interesting characteristic of Subutex is that even at higher doses, it does not tend to depress the heart rate or breathing in the same way.
2) It is a partial Antagonist. This means that Subutex will block the effects of other opiates and you will not get a high.
3) Subutex has a very high affinity for the opiate receptor, more so than Heroin. What this means is that Subutex will preferentially bind to the opiate receptor. If there is any Heroin in your system and you take Subutex, the Subutex will displace the Heroin from the opiate receptors in your body, and you will be almost instantly precipitated into withdrawal. Furthermore, Subutex will remain active at the receptor for up to 72 hours. Any further Heroin (or other opiates) that you try to use on top, will not work.
The way that people are induced onto Subutex, after using Heroin, methadone, or other opiates, is to cease using for 48hrs. This means that at 48hrs you would be in active withdrawal. This is the time that Subutex is introduced. The Subutex will attach to the opiate receptor and lessen the withdrawal symptoms. The dose can then be slowly increased over a few days in order to stop withdrawals and stabilise for maintenance therapy, (eg. as an alternative to methadone maintenance); this is often a good way to go, as it gives you time to get the rest of your life together - look after your health, sort out your finances, get a job if you don't have one, get away from the using crowd, put a support network into place...before considering detoxing completely.
Normally, when starting on Subutex with a view to detox-ing straight away, again - you would increase the dose gradually over a few days to a point where you felt comfortable - no withdrawal symptoms, and then start decreasing slowly - it can be done over 10-14 days fairly comfortably, or over a longer period of time if necessary.
This is an outline of how it is done; I hope it is useful to you.
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31-10-2004, 21:39
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