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PostPosted: Tue Nov 01, 2011 7:51 am 
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Buprenorphine's ceiling dose varies from person to person. If it was fixed, then I assure you that we could google the answer in one second. Medical research is all over that kinda thing! :D

Quote:
Contrary to someone else's advice on here, if >4mg made you feel too sedated, I wouldn't suggest going up 2 mg every dose.


Ironic, what's with the passive aggression? If you disagree with someone else's opinion, I suggest you let them know in private. It's what most adults do.

I take 12mg a day, because if I take under 8mg, I burn through my Suboxone so fast that I go into withdrawals by mid-afternoon. It is also impossible to take it more than twice a day. My prescribing doctor said it's likely that I have a greater presence of a certain liver enzyme than most people. Because of my freaky metabolism, when I was using I could have 8mg buprenorphine in the morning, and use heroin mid-afternoon with no blockade.

The point I'm making is that, your constant one-size-fits-all advice that you throw around can be dangerous. And if you will only be happy on a forum where everyone agrees with you, then maybe opiophile would be the place. There's some quality recovery to be found in there! :lol:


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PostPosted: Tue Nov 01, 2011 1:18 pm 
tearj3rker wrote:
Buprenorphine's ceiling dose varies from person to person. If it was fixed, then I assure you that we could google the answer in one second. Medical research is all over that kinda thing! :D

Quote:
Contrary to someone else's advice on here, if >4mg made you feel too sedated, I wouldn't suggest going up 2 mg every dose.


Ironic, what's with the passive aggression? If you disagree with someone else's opinion, I suggest you let them know in private. It's what most adults do.

I take 12mg a day, because if I take under 8mg, I burn through my Suboxone so fast that I go into withdrawals by mid-afternoon. It is also impossible to take it more than twice a day. My prescribing doctor said it's likely that I have a greater presence of a certain liver enzyme than most people. Because of my freaky metabolism, when I was using I could have 8mg buprenorphine in the morning, and use heroin mid-afternoon with no blockade.

The point I'm making is that, your constant one-size-fits-all advice that you throw around can be dangerous. And if you will only be happy on a forum where everyone agrees with you, then maybe opiophile would be the place. There's some quality recovery to be found in there! :lol:


You asked me what was with the passive agression and then said "If you disagree with someone else's opinion, I suggest you let them know in private. It's what most adults do." In the same paragraph! You sir, are funny.

I am happy to debate anything I say, and back up everything I say with evidence. I don't need to let anyone know I disagree with them, because what I think matters less than the medical evidence that I cite myself with. When I cite something, I share the opinion of doctors who did a study, or maybe a doctor who wrote an article, but the opinion is not just mine and mine alone.

"And if you will only be happy on a forum where everyone agrees with you, then maybe opiophile would be the place. There's some quality recovery to be found in there!"

Am I not allowed to debate? If a moderator disagrees with me, should I just back down, even if they can't back up what they are saying because it is wrong?

I have a thyroid disorder and a freaky metabolism too, so I dose 2x per day. I don't have any strange enzyme, but I used to put $100 of heroin a day in my arm (at 5" and 100ish lbs). Now, just a little over a year later, I have successfully tapered down to <2mg>4 mg doses, the harder it is going to be to do a successful taper.

For the record, I think people should be ALLOWED to remain on buprenorphine forever, but it should be a last resort, and should be discouraged. Don't kid yourself. More drugs in the body = less healthy body..and I'll steal a sentiment from Opiophile now: THERE AIN'T NO FREE LUNCH!

With your "freaky metabolism problem," did >4 mg make you feel too sedated? The only advice I gave was the suggestion that if >4 mg made someone feel too tired, than a dose increase was probably not for them. Do you disagree with that statement?

Many people complain about side-effects and feeling "foggy" and tired on Suboxone. A lot of people DON'T REALIZE that VERY OFTEN (don't wanna make absolute statements) the lower you go, the less side-effects you will have.

So, what is your advice to the person who is tired from the Suboxone? Do tell.

P.S. That snide little remark you made about Opiophile and recovery is pretty telling about your personality. You think you are better than those people? Guess what. We are all opiate addicts, most of us taking an opiate every singe day. YOU are NOT better than any one of them, just because you are a moderator on Suboxforum. What does that prove, anyway?


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PostPosted: Tue Nov 01, 2011 1:20 pm 
SubbyTaker401 wrote:
hatmaker510 wrote:
OK, this is getting old. I'm not going to argue with you. Everyone on this site and Dr. Junig and I are all on the same page. Maybe he'll pop in and explain it. But what I'm thinking is perhaps you came here trolling, so it wouldn't matter what he were to say anyway. This site is for support and it seems that maybe you've just come here to stir up shit. Maybe just ease up on the argumentativeness?

Oh and BTW, opiate receptors cannot be "permanently damaged". Remove the opiates and in time they will return to normal. Again, refer to Dr. Junig.
[font=Tahoma] [/font]


Ok no offence but even though i don't agree with the other poster who is saying the ceiling effect is 16-32mgs and i read the link he posted and can see he has misunderstood i do think you can calm down, no need to get all edgy, both of you are breaking the rules on this site which say ''Please do not debate'' and ''please do not discuss the pros and cons of suboxone''.. Just because you both believe in seperate things doesnt mean you can bark off a additude, just ignore it. You seem to have a large ego or something, why do you get so offended? Maybe i suggest not participating in forums if you can't handle it? If theres one thing i know about the internet,, its that EVERYONE has there opinions, EVERYONE is judgemental and EVERYONE just lovesss to debate and argue. He isn't a troll, he hasn't done anything but comment on what he believes to be true and because he hasn't ''dropped it'' you get all upset. Noone has to believe you just because you said something. If you can't take the heat, get the F out of the kitchen.


Oh and btw to all the Users, Not ALL Dr's/Sites are 100% correct, Just because Dr's have there varying opinions doesn't mean its the truth. Just like scientists, etc.


You disagree with the SAMHSA website? About what, specifically? Please elaborate.

You think I misunderstood the SAMHSA link? How? Please explain.


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PostPosted: Tue Nov 01, 2011 5:17 pm 
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Ok, what were we arguing about again?

To recap:

Ironic argues that:

Quote:
I don't know if this topic has been addressed here yet, but I find that with buprenorphine, less is more..and many on the interwebz seem to agree.

Doing some reading, I have learned a (simple) explanation: At <4 mg of buprenorphine per day, there are still receptors open to norbuprenorphine, which is what buprenorphine is metabolized into. Norbuprenorphine is more depression/pain relieving than the buprenorphine itself.


For the record, this topic actually has been addressed here before. Some people agree that they do better, have less side effects and a fatter wallet on a lower dose of Suboxone. Other people experience the opposite - they feel better on a higher dose, have less cravings, manage pain better, etc.

It appears there is not a consensus on this issue, but the "less is more" idea is certainly food for thought.

I am personally interested in learning more about the norbuprenorphine issue and will look into that as time allows.

And then...

It seems the "ceiling level" or "ceiling effect" thing became a point of contention. Ironic understands the term "ceiling level" to mean "the dose at which the agonist effects of bperenorphine reach a maximum and do not continue to increase linearly with increasing doses of the drug" which is stated by SAMHSA to be between 16 and 32 mgs of bupe taken sublingually per day.

Breezy Ann and others understand the "ceiling level" to be the minimum dose of bupe at which a person's opiate receptors would be completely engaged, thus preventing cravings and withdrawal symptoms. They also understand this dose to be the dose at which the opiate-agonist effects of buprenorphine level off. Per Dr Junig, this dose is around 4mgs per day. Also per Dr. Junig, the benefit of taking a dose higher than 4mgs per day, despite the fact that this is where he indicates the ceiling effect is reached, is that the higher dose guarantees a stable blood level of buprenorphine at a level sufficient to prevent the patient from feeling withdrawals or the ups and downs that may be felt at lower-level dosing. This stability is held to be an important factor in a patient's ability to break the response-reward cycle that is the hallmark of addiction.

So it appears that we have a conundrum! Someone here must be wrong. Is it SAMSHA or Dr. Junig? 16-32mgs or 4mgs?

What is the TRUTH?

I'm going to attempt to make the case that BOTH understandings are true. Hang on, I'm about to get all pedantic.

First, let's get clear on what we're actually talking about. I'm sure that we've all seen some variation on this chart:

Image

This chart illustrates the "ceiling effect" of buprenorphine. The ceiling effect is the point at which increased doseage no longer creates an increase in "opiate effect."

What do they mean by opiate effect? Is it a measure of feeling of euphoria, withdrawals, or analgesic effect? Can they actually look at our brains or do a blood test to see what percentage of our opiate receptors are occupied? No.

They are measuring increased respiratory depression as indicated by Pco2 (partial pressure of carbon dioxide) levels. When Pco2 levels no longer increase with increased doseage, you have encountered the ceiling effect. Respiratory depression is how they measure "opiate effect," which makes sense because it can be objectively measured and it relates to the safety of the medication. But it doesn't really tell us much about the subjective experience of the patient and it doesn't directly describe things like how many receptors are occupied, level of cravings or withdrawal symptoms, etc. For example, this measure does not tell us that at 4mgs, 95% of your opiate receptors are engaged while at 16mgs 98.7% are engaged. All it tells us is how repiratory depression correlates with buprenorphine dose.

Samsha, NIDA and the rest of the Feds have determined that the dose where this ceiling effect occurs is between 16mg and 32mgs sublingually. Dr. Junig says 4mgs. How can they both be right?

Look at the line on the chart that represents Buprenorphine. You'll notice that it begins to rise in a linear (straight) way. Then, right around the part of the line that is directly beneath the red arrowhead, the line begins to curve. This is the point on the curve where it begins to transition from a steeper slope to a shallower slope.

This point on the line is known as "the knee in the curve." It is also known as "the point of diminishing returns." This is the point where the level of opiate effect begins to decrease exponentially with each subsequent increase in doseage.

The "knee in the curve," "point of diminishing returns" is also known as "the sweet spot." This point indicates the point where you are getting the MOST opiate effect for the LEAST dose of buperenorphine.

Because the graph doesn't supply any raw data, I can't say what this "sweet spot" dose is. But looking at the chart, we can reasonably state that the "sweet spot" dose is lower than the 16-32mg dose indicated by that pointing arrow as where the "ceiling effect" occurs.

Dr Junig has made known his opinion that the "ceiling level" for bupe is around 4mgs sublingually. I think it is entirely possible that what he has found is that the 4mg dose is right in that "sweet spot" indicated by the bend in the line of the graph. It is below the dose found to be the point where Pco2 levels no longer continue to rise, but it is not far enough below that level to really matter as far as the lived experience of the patient is concerned.

Looking at this chart it's possible to see that the actual difference in opiate effect (as measured by respiratory depression) between a dose of 4-8mgs and a dose of 16-32mgs is pretty negligible. It's a pretty flat line. But we don't go around as Sub patients taking measure of our respiratory depression and resultant Pco2 levels to determine what dose is best for us. We subjectively measure how we feel physically, mentally and emotionally. How are our withdrawals? Our cravings? Our mood?

I think that what Dr. Junig is getting at with his 4mg ceiling is that 4mgs is the dose at which he finds most patients begin to see those diminishing returns with incresed doseage. More than 4mgs may get you slightly more "opiate effect" as measured by Pco2, but it really doesn't get you more "opiate effect" as measured by patient experience with regard to cravings and withdrawals. To Dr. Junig, 4mgs is the dose where the line on the graph flattens out enough that the differences between 4mgs and a higher dose begin to matter significantly less.

(The one caveat that he places on his 4mg ceiling estimate is that Sub patients will want to take a high enough daily dose that they do not dip below the blood level concentration required to maintain that 4mgs, thus eliminating withdrawals and ups and downs. For him, this is where the higher doses come into play.)

To Samsha, NIDA and all, the ceiling effect is the point where Pco2 no longer increases with dose. Period.

I argue that Dr. Junig and the Feds are BOTH right - because the actual difference between the "opiate effect" of 4mgs and the "opiate effect" of 16-32mgs is insignificant enough that it becomes basically meaningless.

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Last edited by Diary of a Quitter on Sun Mar 11, 2012 1:11 am, edited 1 time in total.

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PostPosted: Wed Nov 02, 2011 12:51 am 
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Ironic wrote:
I am happy to debate anything I say, and back up everything I say with evidence. I don't need to let anyone know I disagree with them, because what I think matters less than the medical evidence that I cite myself with. When I cite something, I share the opinion of doctors who did a study, or maybe a doctor who wrote an article, but the opinion is not just mine and mine alone.


There's a difference between being a qualified medical professional Ironic, and a googlademic. A googlademic isn't a qualified medical professional. They get little bits of information from various sites they've googled to back up their opinion.

Here's what you're forgetting Ironic. You are not qualified to interpret these studies! Unless you can prove you have a degree, your interpretation of every medical document you read could be completely askew. Medical students do whole semesters/years in interpretation of medical studies. Have you?

The people you have been arguing with for the most part are simply mirroring the research findings of Dr J, someone who is qualified to speak on the subject. You appear to simply be a googlademic with no qualification, who believes their opinions to be more valid than others.

Oh yes Ironic. If you want me to spell it out. Stop being a child, be an adult, have a long think about what's annoying you, and message breezy_ann. Discuss your issues politely, because none of us on this board wants to see you get too big for this place.

You have made the occasional real quality supportive post in this place, which is probably why you're still here. So please, for our sake, just message her, sort it out so we can waste our time on better things. Like Angry Birds.

Quote:
P.S. That snide little remark you made about Opiophile and recovery is pretty telling about your personality. You think you are better than those people? Guess what. We are all opiate addicts, most of us taking an opiate every singe day. YOU are NOT better than any one of them, just because you are a moderator on Suboxforum. What does that prove, anyway?


I'm a moderator? Wow.. When did that happen? Seriously!? I could ban you all along? :lol:

Nah. Ironic, you appear mistaken. I don't think I'm better than anyone else. From someone who spent a bit of time there a while back, I can assure you that the majority of people there are still using their drug of choice, injecting drugs, snorting drugs etc. I'm sure many want to get clean, but (at least when I went there) most of those people were still using, or had recently relapsed. In my opinion, it's the kind of board that a person has to walk away from when they decide to get clean. But that's my opinion, and I understand you may disagree, and we'll likely "agree to disagree" on this one.


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PostPosted: Mon Nov 07, 2011 9:13 pm 
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This post hurt my head. It's exactly why I don't read much here anymore. Mr. Ironic, just because you think something is fact doesn't make it so. It makes it your opinion, supported by what you have read and theorized. The tone was argumentative from the start. My opinion or no opinion. I wish this thread and those liked it were stpped in their infancy as there is nothing productive to anyone here.


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PostPosted: Wed Nov 09, 2011 2:43 am 
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I read where "Ironic" posted the link as proof to his claims about the ceiling but clearly anyone reading it can see he was not understanding what he was reading at all. It didnt state anywhere that the ceiling was 32mg. Im on 8mg and thats the perfect dose for me by my own experiences with switching doses to find whats best so since i guess i just wanna take more meds then i need since its not "medically" needed. I think you should do alot more research before you come on here posting things you "CLAIM" to be facts because most people on Bupe know that what you're saying isnt facts and can def. prove you wrong.. You clearly dont know too much about this drug so I dont think its good to be giving out info to people like you do know.. Its very misleading and could hurt someones recovery. You clearly are not a doctor and not an expert so you shouldnt be acting like you are.

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PostPosted: Sun Mar 25, 2012 8:59 pm 
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I joined this forum specifically to respond to this topic...
I definitely agree that "less is more". While I can't back up any of the 'scientific' reasons that some people here have posted for it, I definitely feel "better" with my 2x a day 2mg dose than I did when I was taking 1x a day dose of 8mg. Definitely not a "euphoric high" but a subtle sense of well-being. I'm more chatty, better mood and am more willing to go out and do things. Just my two cents, though..


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PostPosted: Mon Mar 26, 2012 3:07 am 
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Welcome adrenaline!

For those people whose docs have put them on too high a dose, less definitely is more. It sounds to me that 8mg was just too much for your level of opioid tolerance.

The issue many people had with Ironic's statement was that she claimed that less-is-more for everyone. It sounded to me like a one-size-fits-all statement - that everyone should be on low doses, that nobody needs doses over 4mg. It just isn't true. Rates of metabolism vary so much between people, as to tolerance levels. One person may need 0.5mg of Sub to stave off their cravings. Others may need 16mg!

Bear in mind that Ironic was snorting her Sub. I always wondered if she was on a higher dose, whether she'd have bothered to do that.


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PostPosted: Sat Mar 31, 2012 12:55 am 
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I just have to applaud this post. I haven't logged in here in a while but your responses were PERFECT. This is a
senseless debate, and you made some sense out of it :)

Bottom line is, yes, 16-32 is the federal agreed upon amount. But between 4mg-16mg you won't notice
a hell of a lot of a difference unless you are taking daily and want to saturate your receptors, as hatmaker
was saying.

In a way, everyone is right. Let's all hug and take our subs tonight folks.


:) (sorry I know this is an old thread)



Diary of a Quitter wrote:
Image


Ok, what were we arguing about again?

To recap:

Ironic argues that:

Quote:
I don't know if this topic has been addressed here yet, but I find that with buprenorphine, less is more..and many on the interwebz seem to agree.

Doing some reading, I have learned a (simple) explanation: At <4 mg of buprenorphine per day, there are still receptors open to norbuprenorphine, which is what buprenorphine is metabolized into. Norbuprenorphine is more depression/pain relieving than the buprenorphine itself.


For the record, this topic actually has been addressed here before. Some people agree that they do better, have less side effects and a fatter wallet on a lower dose of Suboxone. Other people experience the opposite - they feel better on a higher dose, have less cravings, manage pain better, etc.

It appears there is not a consensus on this issue, but the "less is more" idea is certainly food for thought.

I am personally interested in learning more about the norbuprenorphine issue and will look into that as time allows.

And then...

It seems the "ceiling level" or "ceiling effect" thing became a point of contention. Ironic understands the term "ceiling level" to mean "the dose at which the agonist effects of bperenorphine reach a maximum and do not continue to increase linearly with increasing doses of the drug" which is stated by SAMHSA to be between 16 and 32 mgs of bupe taken sublingually per day.

Breezy Ann and others understand the "ceiling level" to be the minimum dose of bupe at which a person's opiate receptors would be completely engaged, thus preventing cravings and withdrawal symptoms. They also understand this dose to be the dose at which the opiate-agonist effects of buprenorphine level off. Per Dr Junig, this dose is around 4mgs per day. Also per Dr. Junig, the benefit of taking a dose higher than 4mgs per day, despite the fact that this is where he indicates the ceiling effect is reached, is that the higher dose guarantees a stable blood level of buprenorphine at a level sufficient to prevent the patient from feeling withdrawals or the ups and downs that may be felt at lower-level dosing. This stability is held to be an important factor in a patient's ability to break the response-reward cycle that is the hallmark of addiction.

So it appears that we have a conundrum! Someone here must be wrong. Is it SAMSHA or Dr. Junig? 16-32mgs or 4mgs?

What is the TRUTH?

I'm going to attempt to make the case that BOTH understandings are true. Hang on, I'm about to get all pedantic.

First, let's get clear on what we're actually talking about. I'm sure that we've all seen some variation on this chart:

Image

This chart illustrates the "ceiling effect" of buprenorphine. The ceiling effect is the point at which increased doseage no longer creates an increase in "opiate effect."

What do they mean by opiate effect? Is it a measure of feeling of euphoria, withdrawals, or analgesic effect? Can they actually look at our brains or do a blood test to see what percentage of our opiate receptors are occupied? No.

They are measuring increased respiratory depression as indicated by Pco2 (partial pressure of carbon dioxide) levels. When Pco2 levels no longer increase with increased doseage, you have encountered the ceiling effect. Respiratory depression is how they measure "opiate effect," which makes sense because it can be objectively measured and it relates to the safety of the medication. But it doesn't really tell us much about the subjective experience of the patient and it doesn't directly describe things like how many receptors are occupied, level of cravings or withdrawal symptoms, etc. For example, this measure does not tell us that at 4mgs, 95% of your opiate receptors are engaged while at 16mgs 98.7% are engaged. All it tells us is how repiratory depression correlates with buprenorphine dose.

Samsha, NIDA and the rest of the Feds have determined that the dose where this ceiling effect occurs is between 16mg and 32mgs sublingually. Dr. Junig says 4mgs. How can they both be right?

Look at the line on the chart that represents Buprenorphine. You'll notice that it begins to rise in a linear (straight) way. Then, right around the part of the line that is directly beneath the red arrowhead, the line begins to curve. This is the point on the curve where it begins to transition from a steeper slope to a shallower slope.

This point on the line is known as "the knee in the curve." It is also known as "the point of diminishing returns." This is the point where the level of opiate effect begins to decrease exponentially with each subsequent increase in doseage.

The "knee in the curve," "point of diminishing returns" is also known as "the sweet spot." This point indicates the point where you are getting the MOST opiate effect for the LEAST dose of buperenorphine.

Because the graph doesn't supply any raw data, I can't say what this "sweet spot" dose is. But looking at the chart, we can reasonably state that the "sweet spot" dose is lower than the 16-32mg dose indicated by that pointing arrow as where the "ceiling effect" occurs.

Dr Junig has made known his opinion that the "ceiling level" for bupe is around 4mgs sublingually. I think it is entirely possible that what he has found is that the 4mg dose is right in that "sweet spot" indicated by the bend in the line of the graph. It is below the dose found to be the point where Pco2 levels no longer continue to rise, but it is not far enough below that level to really matter as far as the lived experience of the patient is concerned.

Looking at this chart it's possible to see that the actual difference in opiate effect (as measured by respiratory depression) between a dose of 4-8mgs and a dose of 16-32mgs is pretty negligible. It's a pretty flat line. But we don't go around as Sub patients taking measure of our respiratory depression and resultant Pco2 levels to determine what dose is best for us. We subjectively measure how we feel physically, mentally and emotionally. How are our withdrawals? Our cravings? Our mood?

I think that what Dr. Junig is getting at with his 4mg ceiling is that 4mgs is the dose at which he finds most patients begin to see those diminishing returns with incresed doseage. More than 4mgs may get you slightly more "opiate effect" as measured by Pco2, but it really doesn't get you more "opiate effect" as measured by patient experience with regard to cravings and withdrawals. To Dr. Junig, 4mgs is the dose where the line on the graph flattens out enough that the differences between 4mgs and a higher dose begin to matter significantly less.

(The one caveat that he places on his 4mg ceiling estimate is that Sub patients will want to take a high enough daily dose that they do not dip below the blood level concentration required to maintain that 4mgs, thus eliminating withdrawals and ups and downs. For him, this is where the higher doses come into play.)

To Samsha, NIDA and all, the ceiling effect is the point where Pco2 no longer increases with dose. Period.

I argue that Dr. Junig and the Feds are BOTH right - because the actual difference between the "opiate effect" of 4mgs and the "opiate effect" of 16-32mgs is insignificant enough that it becomes basically meaningless.


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PostPosted: Sat Mar 31, 2012 1:40 am 
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No euphoria, are you crazy? So my extreme euphoria from 16 Mgs is fake? Hmm


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PostPosted: Sat Mar 31, 2012 2:38 am 
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Hi oclafsti,
First, I want to ask why you listed this under less is more? Seems to me that 16 mg’s is a med to larger dose for some to most of us. if you don’t mind me asking, how long have you been taking sub’s and did you start out on 16mg’s or more?
I have been on sub’s for eight months now, I started on 16 and was tapered to 8mg’s, however I have just changed doctors for lack of care I was getting with the one and my current Doc says that the other tapered me to soon considering my history and I am now back on 12mg’s.

With that said, I can only think of a couple times when I felt an effect from my subs and I would not have really called it euphoria, was I feeling the opiate in the subs maybe, why? Do not know. What I do know for myself is that it is not something that lasted and I soon started to feel normal, like myself without ever had been on drugs. The best part though, I do not crave drugs any longer and I can live a normal life without the insane obsession in my head.

There are many good people on this site and I am sure you will hear from some of the others who will be able to give you a medical explanation of why or what you are feeling, and yes it could be fake.

I know for myself that I can twist things so much that I sometimes believe them myself. The mind is a very powerful thing. I would compare it to the same thing as when in full blown addiction, if my back hurt it really hurt, in fact it hurt so bad I could hardly walk or stand and I had to have people get things for me because it was so terrible and therefore needed not hydro’s but oxys or perks, Darv. Etc. and I myself really believed it. Is it the same? I think maybe kinda.

I hope that this will not make you want to stop treatment with subs, talk to others and your doc. I bet that in just a VERY SHORT TIME, like a day or two this will stop and you should feel NORMAL.

Anything and everything I say is intended to help others and I apologize for anything that may offend others. My intentions are only good. I am not a medical profession and, I only talk from my experience.


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PostPosted: Sat Mar 31, 2012 8:44 am 
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If you're feeling stoned from your dose of sub, your dose is far too high.

oclafsti, it sounds like you have a low tolerance to opioids at the moment, a tolerance that would probably require a dose well under the ceiling.

I know how what you're saying though. When I first went on Sub, I was put on 4mg. Before that I was using heroin maybe once or twice a week? I'd only experienced mild withdrawals. After the sub I was well stoned for a couple of weeks! Did I tell my doctor? No. I was loving it! Ultimately, I paid the price. Within 2-3 weeks the buzz faded and my tolerance went up a LOT. In the end I ended up MORE dependent on opioids than I did before I went on Sub.

Any time our tolerance to opioids goes up, there are lasting changes in the brain, and it becomes harder to live without opioids in the long run. Ultimately you're only hurting yourself by staying on a dose that's too high for your needs.


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PostPosted: Thu Jan 08, 2015 1:35 pm 
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Suboxone is preffered because it does not usually build a tolerance in people, this is why you dont need more and more over time to feel the same, one of the benefits of it, also it does not as easily cause physical dependance, it does but not as fast or drastically, as full agonists, im surprised you were high for weeks off the stuff but hey thats cool, as far as tolerance goes there should be none, just the fact you cant feel euphoria anymore


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PostPosted: Thu Jan 08, 2015 1:40 pm 
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Tolerance going up doesnt cause irreversible changes in the brain only a surplus of receptors which need to be filled, the brain and rest of body replaces cells quite fast and this surplus of receptors will recede with time its the other changes made in neural pathways, memory storage cognitive responses that dont go away


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PostPosted: Thu Jan 08, 2015 1:47 pm 
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As far as th less is more, when using it to combat acute withdrawels there is no less is more, a heavy habit will require more bupe to stop the withdrawel syndrome no two ways around it, but will taking more than usual get you high? No you haveto be regularly on below .5 mg then use more than usual and it can be just as intoxicating as heroin without any rush of course


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PostPosted: Wed Jun 24, 2015 10:59 am 
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Sorry to drag up an old post but leaving receptors open in order to fill them with norbuprenorphine shouldn't work.

What about the PGP enzyme pumping the norbuprenorphine from the cells? It doesn't cross the BBB.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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