Subs (Buprenorphine) Not Working

[kat2005]

Hi

My bf had been prescribed subs and started taking them however he is still feeling very anxious and ends up going to see his dealer every day.
Although i know its mainly psychological and that the subs must be working a little i want to help him get through this but hes so scared.
I was wondering if maybe the subs arent working because of the amount hes been using? (about £80 a day) and would he be better asking for methadone so he can cut right down before taking subs?

any advice would be great because i feel really lost and dont know how to help him, i have no experience with drugs myself and im struggling to understand how he feels but i do know that he is the most amazing person ihave ever met and however hard this or and however long it takes im going to be there with him through it all, i just want to know the best way to help him.

thanks
xx

[Orchid_Suspiria]

The amount is probably not it.The truth is they don't work well for some people.They didn't work very well for swim.Ofcourse lifelong dependency on methadone is not something swiy wants either.Swim's advice would be to try the subs abit longer and they might work hopefully,if not then it is time to start asking questions.

[adzket]

firstly dont use i even when talking about someone else, then swim would say he has to stop useing or cut down first befor going onto subutext, basicaly while he is taking subutext and gear he will feel crap as subutext block's receptors in the brain stopin opiates binding to them making him cluck more. what dosege is swiy's bf taking? and what waight of gear is he useing as amount of money could meen anything? which is again somthing to keep out of these forums have a quick read of the rules', swim hopes this helps exsplain why he is still feeling rubbish, swim would advise not going onto methadone unless 100% needed people end up worse than with gear, also r the 100% up for giving up as if not you have a battle on your hands, every user know it will feel like crap for a bit and have to put up with it if they truly want to be clean.
also serch threw the forum aswell as there is alot of usefull information about subutext and h use and geting clean. hope all works out for swiy and bf.

[Spyder]

SwiS tried suboxone for about a year on and off, but is currently on Methadone (for the past 2-3yrs., 115mg). This happened mainly due to very weak will power, to be honest. SwiS would use his suboxone as a safety net to keep sickness away when he couldn't score any H. He played this game for a while, but realized he needed to be stabilized on a maintenance program. That being said, swiS has seen several success stories (although many more uses as a 'safety net'), getting clean w/ Suboxone takes will-power and a true desire to do it...NOT for anyone else but swiYourself!

swiS seconds swiadzket, at least mostly....Taking suboxone, then a bit later thinking, "this isn't working...better go get some shit"....then taking the shit...makes things much much worse. As swiAdz pointed out, the 'strength' of the buprenorphine to 'hold onto' the opiate receptors, makes most of the H dosage useless. Many times this leads to using even MORE....BAD BAD IDEA!! The Naloxone in suboxone is there to keep from abusing them, although it's possible this could be a problem. SwiS knows a few people who used them to come off of low dose (40mg) Methadone, they used Subutex (w/o the 'blocker') this seemed to be better, less stomach discomfort, etc.

Also, it is POSSIBLE that the buprenorphine dosage is too low based on what he was taking? Doubtful, but could be..To reiterate swiAdzket, how much H was he doing and how much suboxone is he prescribed (not in money, in weight)?

All the best of 'luck'....one day at a time......S

PS: SwiS should point out that although very happy w/ the Methadone program, it does haunt him pretty much daily what would happen if he had to stop for some reason, or if he will ever be able to....It is a VERY serious commitment and should really be the LAST resort....good luck!!!

Reputation Comments on this post:

good point, thanks for adding to post!

[adzket]

Originally Posted by Spyder

SwiS tried suboxone for about a year on and off, but is currently on Methadone (for the past 2-3yrs., 115mg). This happened mainly due to very weak will power, to be honest. SwiS would use his suboxone as a safety net to keep sickness away when he couldn't score any H. He played this game for a while, but realized he needed to be stabilized on a maintenance program. That being said, swiS has seen several success stories (although many more uses as a 'safety net'), getting clean w/ Suboxone takes will-power and a true desire to do it...NOT for anyone else but swiYourself!

swiS seconds swiadzket, at least mostly....Taking suboxone, then a bit later thinking, "this isn't working...better go get some shit"....then taking the shit...makes things much much worse. As swiAdz pointed out, the 'strength' of the buprenorphine to 'hold onto' the opiate receptors, makes most of the H dosage useless. Many times this leads to using even MORE....BAD BAD IDEA!! The Naloxone in suboxone is there to keep from abusing them, although it's possible this could be a problem. SwiS knows a few people who used them to come off of low dose (40mg) Methadone, they used Subutex (w/o the 'blocker') this seemed to be better, less stomach discomfort, etc.

Also, it is POSSIBLE that the buprenorphine dosage is too low based on what he was taking? Doubtful, but could be..To reiterate swiAdzket, how much H was he doing and how much suboxone is he prescribed (not in money, in weight)?

All the best of 'luck'....one day at a time......S

PS: SwiS should point out that although very happy w/ the Methadone program, it does haunt him pretty much daily what would happen if he had to stop for some reason, or if he will ever be able to....It is a VERY serious commitment and should really be the LAST resort....good luck!!!

thanks swispyder thats what i was trying to get across, but swim did not get on with subbys' after being on methadone for yrs they came down to 10mls' then whent on subbys they felt to straight and sober even from a tiny amount of methadone they soon started swallowing the subutext in the chemist so they could see them suposidly take it then go use knowing know one would no as they where medicated. they whent back to methadone and now coming down again not used now for 8 weeks and is on les methadone than perscribed just in case they have a little slip up that will cover for a few days.

[Spyder]

Yea....SwiS thinks swiWe all come up with this 'great plan' for swiOurselves, in terms of detox...i.e."maybe cut down to this and then that and then use subx....on and on" BUT when it comes down to it, that final 'Break!' is a Bitch, no doubt about it!

SwiS is on 115mg (swiY listed as in mls not mgs, must be in UK????), someone the other day actually said to swiS, "swiYour going to have to kick it someday...." , swiS thought maybe not? Hate to think of it as a life sentence rather than a reduction program, but almost 3yrs in and can't even begin to consider trying to quit.

SwiS has a screw-up every couple months (more use out of boredom than 'craving', really) the H really dosn't even do much, with that dosage of the Methadone. Had a friend quit recently though, she went down to 5mg, then switched to 3x 8mg / day of Subutex (no naloxone), she said she is ok now, but a bit worried about the reduction from the subbys.

Anyway..GOOD LUCK TO ALL....As fucked up and crazy as it sounds, swiS still LOVES opiates! That is really the big problem.....take care....S

[chillinwill]

Originally Posted by Spyder

Yea....SwiS thinks swiWe all come up with this 'great plan' for swiOurselves, in terms of detox...i.e."maybe cut down to this and then that and then use subx....on and on" BUT when it comes down to it, that final 'Break!' is a Bitch, no doubt about it!

SwiS is on 115mg (swiY listed as in mls not mgs, must be in UK????), someone the other day actually said to swiS, "swiYour going to have to kick it someday...." , swiS thought maybe not? Hate to think of it as a life sentence rather than a reduction program, but almost 3yrs in and can't even begin to consider trying to quit.

SwiS has a screw-up every couple months (more use out of boredom than 'craving', really) the H really dosn't even do much, with that dosage of the Methadone. Had a friend quit recently though, she went down to 5mg, then switched to 3x 8mg / day of Subutex (no naloxone), she said she is ok now, but a bit worried about the reduction from the subbys.

Anyway..GOOD LUCK TO ALL....As fucked up and crazy as it sounds, swiS still LOVES opiates! That is really the big problem.....take care....S

is there any harm staying on methadone the rest of one's life? that way, one would not have to worry about detoxing off of it but of course one would have to go through all the trouble of getting methadone daily ....sorry about getting off topic but just reading this post made me curious

[Spyder]

That's swiS's constant pecking in his head....'will I be on this forever'

Personally, swiS has NO PROBLEM...staying on it every day...forever. No real physical side effects are to be had, except maybe the weight gain (at least for me 25lb), although most is probably just because swiS gets hungry after taking....

The only issue is the 'Leash' it forms, there is "Guest Dosing" at other facilities is one were to go out of town, BUT this requires a decent amount of notice (at minimum a week or two), also, privliges if Urines are clean can get up to going only 1 time per week. But there still is that chain holding swiY to this place.....

Don't know....only time will tell, but for now, swiS will be status-quo...what can swiYa do?

Take care...S

[Richard_smoker]

Originally Posted by kat2005

My bf had been prescribed subs and started taking them however he is still feeling very anxious and ends up going to see his dealer every day.
Although i know its mainly psychological and [know] that the subs must be working a little i want to help him get through this but hes so scared.
I was wondering if maybe the subs arent working because of the amount hes been using? (about £80 a day) and would he be better asking for methadone so he can cut right down before taking subs?

ok..for the original poster, i find some things that are not "alien"-strange, but there's definitely SOMETHING strange about the situation that you're describing...you know, it might be a language/cultural thing...because there are quite a few blanket assumptions that are made (i underlined for clarity), and some places in questioning that reveals holes in the informative area of the question...

NOTE to kat2005, please don't be offended by my questions & probing...just my nature, and part breaking-down one big problem into a handful of smaller, more-easily managed problems...by the way, you'd better believe that sooner or later, this problem will become a matter of life & death...eventually, it seems to be the inevitable path...that is, without an organized and effective type of recovery.

you say you don't know anything about drugs, so I think it's appropriate for you to realize that IV Drug Abusers, aka "IVDA" have a several diseases that they are somewhat prone to (especially compared to non-IVDA people). the basic diseases/problems start with track marks, and move up to cellulitis and abscess (a collection of infection and pus located in the soft tissue under the skin, collapse of veins, vein valvular damage, blood-borne bacteria infections that frequently cause right-sided staph infections ON THE HEART VALVES! this is a scary, terrifying experience and if he gets this, it will serve as his life & death experience to maybe help open his eyes.

IVDA's have an high rates of positive heaptitis C and B. Both can be transmitted from either sharing needles or heavy sexual contact. And then there's the dreaded HIV/AIDS virus as well. There is more to recovery than simply exchanging one narcotic opiate for another. whether he agrees to go 'get tested for these diseases' or not, doesn't make any differnece to YOU. You need to go and get this labwork done. one reason is because there is a hepatitis B vaccination that you probably have not gotten (unless you work in healthcare or possibly if you admitted to a physician that you were maybe permiscuous sexuallly or dated an IVDA...don't wait around for this part. it is very important for you know exactly what your blood serologies include.

perhaps the worst position that you could take at this time is to become an "enabler" of his problems. Anytime, he can count on you and your 1st-hand witness to something that "causes him slip" and he ends up toing back to his H dealers, then you are enabling him. but you know, this is usually the case with a spouse or singificant other--they usually fill the position of enabling the addictive behavior, and this can be manifested in many different ways...when you say "i don't know anytyhing about drugs," it throws up a GIGANTIC red flag that you are being taken advantage or in some way, or you are simply one giant addiciton enabler. Sorry to be the one to tell you this, and granted i don't know you & have never seen you, but still, the chances of you being a huge enabler is over 80%.

Some others: if you give or loan him money or your car while he is doing both the bupe & the H, then you are again, an enabler.

First off, there are several things that you REALLY need to realize and accept as fact if you're going to be of any assistance to this guy.

1. if he is honestly taking the subutex/suboxone every day as prescribed, then

when you say that he ends up going to meet his dealer at the end of each day, you're basically telling us that swiy TAKES his correct, prescribed dose under-the-tongue...every single day...and then later, on that same day, swim is able to shooting up H??? the amount of H that it would take to realistically overwhelm the remaining free opiate receptor sites would be ASTRONOMICAL.... i know a guy who took 12 lortab 10's in one night and didn't feel a THING because he takes daily sub.

I hate to be the one asshole or devil's advocate, but I've gotta say that from the looks of it...my first impression is quite simple.

He's not telling you the whole story.

I could be wrong about my initial guesses...I suppose that there's a chance that his dose is far too low of sub, and indeed his receptors must be mostly un-filled...usually a simple bump in dosage will treat this problem. but going and scoring heroin will do nothing at ALL to help him...it won't even make him feel normal. beause the bupe will be standing guard at the receptor sites, saying "stay off the grass" to all the H molecules that float past, leading to no effect or veryvery very little effect.

I think that if every thing you've told us is completely true and accurate, and the problem is something i've already mentioned, then he's selling his bupe tabs for big street prices, then taking that money and spending it on heroin. tell me this, why did he decide go get on the bupe anyways??? doesn't really sound like it was his idea in the first place. It was YOUR idea, wasn't it?

-DICK

[Spyder]

Originally Posted by Richard_smoker

.......blood-borne bacteria infections that frequently cause right-sided staph infections ON THE HEART VALVES! this is a scary, terrifying experience and if he gets this, it will serve as his life & death experience to maybe help open his eyes........-DICK

Very good point swiD, For those who think, "it'll never happen to me...", SwiS spent 3-4weeks in the hospital last year, on constant 'VERY strong' anti-biotics due to a MRSA (meth. resistant staph) Staph in his blood stream spreading to organs. For those who never heard of it, MRSA is a 'SUPER BUG' type of staph, immune to most anti-biotics. It took over a week to just find something that helped, all the while high fever, extreamly sick!!

This MRSA started from an injection site on swiS's arm, caused the arm to be swelled very red and HOT to the touch, before he even knew what was wrong, it had gone to the blood stream. So please all....it CAN happen to you, take precautions.

Also, swiDick....totally agree and that is what swiS was saying...the buprenorphine is so 'strong' to hold onto those receptors it won't let any H in to play. When swiS was on them, it sometimes took 5x+ normal dose (after waiting several hours for sub. to wear down) and he still barely felt anything.

SwiS totally agrees, chances are very very high...this isn't the entire story. If he's wrong and it's merely a dosage issue...Good! He hopes he is.

Good luck, get him to 'Talk' to you! Don't attack!!! it will always but a junkie on the defense....let him help himself!!! Until he's ready for that, forget it! Just don't enable (as swiD said).....try to show him the good reasons to help himself....GOOD LUCK...S

[adzket]

Originally Posted by chillinwill

is there any harm staying on methadone the rest of one's life? that way, one would not have to worry about detoxing off of it but of course one would have to go through all the trouble of getting methadone daily ....sorry about getting off topic but just reading this post made me curious

swim does not think so as a few months ago there g.p sugested to them with there drug worker to stay on it for rest of life they are only in there 20's they said no way i want out of this never ending circle asap they cant cope any more wanted to go to rehab but they refused to pay for it for swim because other users in area have falled and relapsed. so medicaly one would guess not though they ofuasly get money from the nhs for every person they see and every scrip thats writen and supervised by a pharmist.

[Richard_smoker]

it all just depends upon one's definition of the word "harmful"...as each person is different...this word is just "a word"...of course, just in the context of heroin/opiate-addiction, in general, most people would say that a lifelong Rx for methadone would be REASONABLE... not to say that it would be without side effects, but what isnt?

also, one thing that is probably important...when you talk about "lifelong" Rx...usually, this is a translation for "the doctor is not going to string you along for the next year, and then drop you off onto your ass...no one is going to throw you back onto the streets... yes, you can take a deep breath, regroup, do not fear being manipulated by Dr's/medical community..."lifelong methadone" is generally accepted as begin "OKAY!"

sorry for all the bold-faced text...just making point, that usually words are "cues" for something altogether different in meaning than the dictationary sense. in this case, the idea of lifelong Rx being ok, is very important (i think..) for establishing trust b/n medical community and drug-addict....allows you to pick up your life again...

but, consider the changes that most people experience in their 60's & 70's...usually we dope up our old folks...and in this case, careful monitoring is necessary to prevent terrible consequences of methadone/whatever-else...so, very important not to just assume that "lifelong Rx" is any set dose/timing schedule. people change. thats all.
-DICK

[Spyder]

Originally Posted by Richard_smoker

.........people change. thats all.
-DICK

No doubt. Totally agree, guess it's just how they change and in what direction that's really up to them.

S

[moda00]

It is a good point that with suboxone's strength of affinity for the receptors combined with its long half-life that one might not be able to get high fro using heroin like they used to in most cases. I have known those who have specifically skipped taking their subs in anticipation of getting dope later that day or more likely the next day to allow for a good high (which of course is not how they are to be used for recovery but it happens). Not saying he is lying but it could be. However, swim's experience has been that on a low dose of subs and a high dose of dope it can be accomplished. She also noted that one generally will get a rush (which was what she was chasing anyway) even though any subsequent high was greatly diminished so it can still be reinforcing in that way.

It is also quite possible that it is purely psychological. As a former heroin addict swim has injected water when she didn't have dope, simply because the needle and the act of shooting up becomes as compulsive as the drug itself. And if swiy is anxious and associates getting dope with relieving anxiety, that is a pretty strong connection that is difficult to break, even if his use is doing harm or not giving the same effects it used to.

However, taking swiy's post at face value, one important thing that no one mentioned yet is that an adequate dose of opiate maintenance therapy should allow one to be comfortable/free from withdrawals. To decide whether his dose is adequate one would have to evaluate whether he was feeling withdrawals. Are there any other symptoms besides the anxiety? Anxiety is certainly a sign of withdrawal but usually accompanied by other signs- restless legs, goosebumps, hot/cold flashes, sweats, pupil dilation, diarrhea, nausea or vomiting, insomnia, etc. It is also to be expected in early recovery, so even if it is not associated with opiate withdrawal it could be either psychological discomfort due to early recovery (which does get better but only if you stop using and allow your brain to heal!) OR if it is severe and does not lessen or go away after some sober time it could be an anxiety or mood disorder which requires treatment separate from the maintenance (in addition to I mean). It can be hard to distinguish in those cases though, ie. did the person start using due to anxiety, or did the use and withdrawal bring about the anxiety? Dual diagnosis is common, but so is anxiety is early recovery, but one has to get clean first to be able to distinguish.

Suboxone (buprenorphine) does not have a linear dose-response, and it has a ceiling effect, meaning that one can only increase the dose so much to get additional therapeutic effect or benefit. Once a patient reaches around 3o-some mg, going higher will not increase effect. So, as for your statement that it could have to do with the amounts he is using- it is very possible. A high tolerance may require treatment with a full agonist without this ceiling like methadone.

I highly recommend that first he evaluate what is withdrawal manifesting, what is psychological addiction and anxiety from other factors, and then go about increasing the dose and addressing the other needs of recovery through therapy, group meetings, lifestyle changes, etc. If this fails and he main issue is withdrawal and lack of an adequate dose, methadone is the next step. People have negative perceptions of it but honestly the only way one is going to get sober on maintenance meds is if they are on an adequate dose, and if suboxone's dosing does not allow for one's tolerance this is the option, and I believe it works well. However, due to the simple logistics (ie. prescription vs. clinic system) I think suboxone is the better option IF it works for someone's tolerance and the dose is adequate, since there are less hoops to jump through if you will to get the meds. But if it comes down to it I would be happy to share more info on suboxone or methadone from swim's experience and answer any questions the best I can!

Best of luck to you both!!~

[adzket]

swim thinks it needs to be added even though there is a greater risk of geting hep c, most types are now curable, swim got it from a doggy tatoo on holiday and passed on to a partener they have a natural amunity to it and have been helping with finding a cure and swim is awaiting treatment with a type of chemotheripy. so while the risk is there it is not the end of the world like some are lead to belive it is. but swim recomends any i.v or i.m user gets tested regular.