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PostPosted: Fri Sep 30, 2011 2:03 pm 
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.

I currently take 1.25 mg/day (my goal is to stabilize at 1 mg/day for awhile before doing any more jumps), and I feel much better than I did at 8 mg! I just don't see how more than 4 mg/day is necessary after the initial detox period is over. I had a pretty bad IV habit, and I never needed more than 8 mg/day even during the initial detox period. 24 mg/day is a ridiculous expensive waste. I have less side effects, and don't feel "zoned out" or "emotionless." Cravings have actually decreased.

Speaking of ridiculous expensive waste, doctors that refuse to write Subutex instead of Suboxone. Subutex is like $3 per pill at the pharmacies here as opposed to $7! Anyone who would shoot bupe is just stupid, unless they really know what they are doing..I personally would never take that risk..and that is supposedly the "reason" why some refuse to write for Subutex.


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PostPosted: Fri Sep 30, 2011 10:34 pm 
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I agree with you about generic subutex. I pay cash and my suboxone script runs me $450 a month. I was scared to ask my doc for generic after reading peoples experiences but my doc is a very good and understanding guy. So I asked and he said yeah no problem. So luckily my next script will be for bupe and will be around $150!

As far as no one needing above 4mg after Xerox I disagree. Everyone requires different doses and just because you are doing great at a low dose doesn't mean that everyone will. I am on sub for both addiction and pain. I started at 12mg and stayed there for a couple months but I was still having cravings and my pain would creep back in the afternoon. I have now been on 16mg for a couple months and feel much better. I wish I felt as good on a low dose, it sure would save me a lot of money!


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PostPosted: Sat Oct 01, 2011 8:33 am 
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Breezy_Ann wrote:
<snip>
As far as no one needing above 4mg after Xerox I disagree. Everyone requires different doses and just because you are doing great at a low dose doesn't mean that everyone will. I am on sub for both addiction and pain. I started at 12mg and stayed there for a couple months but I was still having cravings and my pain would creep back in the afternoon. I have now been on 16mg for a couple months and feel much better. I wish I felt as good on a low dose, it sure would save me a lot of money!



^^ What does "Xerox" refer to??

Thanks!

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PostPosted: Sat Oct 01, 2011 9:46 am 
Breezy_Ann wrote:
I agree with you about generic subutex. I pay cash and my suboxone script runs me $450 a month. I was scared to ask my doc for generic after reading peoples experiences but my doc is a very good and understanding guy. So I asked and he said yeah no problem. So luckily my next script will be for bupe and will be around $150!

As far as no one needing above 4mg after Xerox I disagree. Everyone requires different doses and just because you are doing great at a low dose doesn't mean that everyone will. I am on sub for both addiction and pain. I started at 12mg and stayed there for a couple months but I was still having cravings and my pain would creep back in the afternoon. I have now been on 16mg for a couple months and feel much better. I wish I felt as good on a low dose, it sure would save me a lot of money!


It isn't just my opinion that Suboxone above a certain mg is wasteful. At 12 mg, your receptors are fully saturated. No room for norbuprenorphine. Maybe google norbuprenorphine if you don't like my explanation?

Bupe is prescribed for pain, did you know that? Temgesic, .2, .4, .8.
If those doses were ineffective, why would they be used for pain?
Don't buy into the bullshit. Our sub doctors would love to have us all on 16 mg.
Reckitt Benckiser just slapped a new name on an old drug and marketed it for ex junkies at extremely high doses.

Don't take my word for it. This topic is heavily discussed on Opiophile and I believe Bluelight too. Try googling it, because like I said, this really isn't just MY opinion.


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PostPosted: Sat Oct 01, 2011 9:55 am 
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Ironic wrote:
Anyone who would shoot bupe is just stupid...


There are many, many different kinds of addicts and recovering addicts on this forum and we ALL deserve EQUAL respect. So please, in the future, refrain from making any such similar statements. Referring to anyone in this fashion is unacceptable. Period.



Now, for the most part, yes, less is more when it comes to suboxone. By that I mean one should be on the lowest dose necessary to abate their withdrawals AND their cravings. And for the cravings that may take 8 mg or up to 12 or even 16 mg.

At or around 4 mg (the ceiling), the receptors are saturated, but going comfortably ABOVE 4 mg, the idea is to KEEP the receptors saturated at all times to keep a steady flow of bupe in the system.

And when it comes to pain patients on suboxone, well, things change, too. There's often higher doses and also multiple day dosing.

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PostPosted: Sat Oct 01, 2011 10:02 am 
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Oh and I forgot one other thing I wanted to say. Using other forums such as Opiophile and Bluelight as citations or sources, well, they aren't exactly studies from a scientific journal. We try to use something more along those lines as references.

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PostPosted: Sat Oct 01, 2011 10:32 am 
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Ex, I was typing on my cell phone and it sometimes changes the words and I don't always catch it. I typed detox but my phone changed it to xerox.

Like Hat said above the sources you listed are not scientific studies, they are other people's opinions. I believe it was Lilly that was explaining when the receptors are actually saturated and if you see this could you stop by and post the explanantion. I don't exactly remember. When bup is given in micro doses it is only to treat pain, it will not treat addiction. It takes doses above the ceiling to to treat for addiction. When one is using sub for both pain and addiction they require higher doses multiple times per day. The pain relieving properties of bup only last for about 6 hours.

Now I have posted here before that I question the ceiling being at 4mg, if it were the case then people should not get an added benefit with anything above. But people do, I do. I take 8mg in the am, 4mg and then another 4mg. Each time I can feel that I took sub (not high) and it helps my pain. When I was on 12mg I was still having some pretty intense cravings and now at 16mg I do not. So for me it is beneficial to take 16mg.

There is also another member here who has an extremely hyper active metabolism and requires higher doses. You may have read other people's experiences and opinions to come to your own which is fine but that does not make it fact. I have nothing wrong with your opinion and can see how you came to that conclusion but based on my experience alone it is not fact. If you have a study proving this then please post it, I have not seen one but if it exists then I will accept it as fact. I have no problem being wrong, it definately will not be the first or the last time.

Please do not take my comments as agressive because I do not mean them to be, I just do not agree.


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PostPosted: Sat Oct 01, 2011 3:29 pm 
hatmaker510 wrote:
Ironic wrote:
Anyone who would shoot bupe is just stupid...


There are many, many different kinds of addicts and recovering addicts on this forum and we ALL deserve EQUAL respect. So please, in the future, refrain from making any such similar statements. Referring to anyone in this fashion is unacceptable. Period.



Now, for the most part, yes, less is more when it comes to suboxone. By that I mean one should be on the lowest dose necessary to abate their withdrawals AND their cravings. And for the cravings that may take 8 mg or up to 12 or even 16 mg.

At or around 4 mg (the ceiling), the receptors are saturated, but going comfortably ABOVE 4 mg, the idea is to KEEP the receptors saturated at all times to keep a steady flow of bupe in the system.

And when it comes to pain patients on suboxone, well, things change, too. There's often higher doses and also multiple day dosing.


You keep saying "the ceiling." The ceiling dose of buprenorphine is ~30 mg. What are you referring to?


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PostPosted: Sat Oct 01, 2011 3:32 pm 
Breezy_Ann wrote:
Ex, I was typing on my cell phone and it sometimes changes the words and I don't always catch it. I typed detox but my phone changed it to xerox.

Like Hat said above the sources you listed are not scientific studies, they are other people's opinions. I believe it was Lilly that was explaining when the receptors are actually saturated and if you see this could you stop by and post the explanantion. I don't exactly remember. When bup is given in micro doses it is only to treat pain, it will not treat addiction. It takes doses above the ceiling to to treat for addiction. When one is using sub for both pain and addiction they require higher doses multiple times per day. The pain relieving properties of bup only last for about 6 hours.

Now I have posted here before that I question the ceiling being at 4mg, if it were the case then people should not get an added benefit with anything above. But people do, I do. I take 8mg in the am, 4mg and then another 4mg. Each time I can feel that I took sub (not high) and it helps my pain. When I was on 12mg I was still having some pretty intense cravings and now at 16mg I do not. So for me it is beneficial to take 16mg.

There is also another member here who has an extremely hyper active metabolism and requires higher doses. You may have read other people's experiences and opinions to come to your own which is fine but that does not make it fact. I have nothing wrong with your opinion and can see how you came to that conclusion but based on my experience alone it is not fact. If you have a study proving this then please post it, I have not seen one but if it exists then I will accept it as fact. I have no problem being wrong, it definately will not be the first or the last time

Please do not take my comments as agressive because I do not mean them to be, I just do not agree.


I have a study in mind. Once my 48 hours are up I will post it. You can't post any links within 48 hours of joining..not my fault.

In regard to the comment about the metabolism: I have a hyperactive thyroid. My metabolism is super fast. I actually dose 2-3 times a day. I still don't or don't know anyone that feels better at 16 mg then <4 mg.


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PostPosted: Sat Oct 01, 2011 4:51 pm 
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Ironic,

As I'm sure you're aware, Suboxone is a partial opiate agonist, as compared to full opiate agonists like oxy, methadone, morphine, etc. And the ceiling effect is therefore also unique to Suboxone/Subutex. Dr. Junig has gone over this in detail many times in his blog and in his videos, but I'll give you a quick rundown again.

The "ceiling effect" occurs at or around 4 mg. At this point the receptors are saturated, but not they are not STAYING saturated. For this reason (and this is all from Dr. Junig), people need to be dosed above 4 mg so that the receptors are KEPT SATURATED at all times. Add to that individual cravings and appropriate doses for people will vary from approximately 4 mg to 16 mg. This is for addiction only, not for the using sub for pain purposes.

Under 4 mg, there is no steady dose of bupe and the receptors are not saturated, therefore suboxone can act more like a full agonist than the partial agonist that it is. Because their dose of bupe will go up and down, they might even feel their doses.

I hope this helps. Please do spend some time on Dr. Junig's old blog posts and videos. They are extremely informative.

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PostPosted: Sat Oct 01, 2011 6:08 pm 
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THat was awesome, hatmaker, THANKS! I haven't been here long enough to see/read/watch the stuff from Dr. Junig... I'll look for it. Great description, though...


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PostPosted: Sat Oct 01, 2011 7:37 pm 
I have a fully cited response proving that the ceiling effect of Suboxone occurs at ~32 mg.

Even though I've been a memer for 48 hours, it still won't let me post links.

Please fix this so we can continue our conversation.


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PostPosted: Sat Oct 01, 2011 7:42 pm 
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You said above that you don't know anyone that feels better at 16 the below 4, while you do not "know" me, I am someone who feels better at 16 than below 4. I understand that it is your experience and your belief what I don't get is why you are trying to convince everyone that they would be better if the did things your way.


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PostPosted: Sat Oct 01, 2011 7:54 pm 
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Oh and I wanted to add you asked in another thread if anyone had heard of a patient on generic prescribed high doses and my answer is yes, me. My Dr. prescribes me 16mg of generic Subutex. If their is a conspiracy with RB paying Dr to keep their patients on high dose sub than my Dr was left out of the loop.


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PostPosted: Sun Oct 02, 2011 10:47 am 
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Ironic wrote:
I have a fully cited response proving that the ceiling effect of Suboxone occurs at ~32 mg.

Even though I've been a memer for 48 hours, it still won't let me post links.

Please fix this so we can continue our conversation.


Just put the link in your post. That's all you have to do. I don't know why it wouldn't let you do that.

I believe you're confusing the ceiling effect with some kind of maximum dosage. Have you read ANY of Dr. Junig's stuff?

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PostPosted: Sun Oct 02, 2011 12:03 pm 
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Here are 2 of Dr. Junig's videos explaining the ceiling effect and why it is important to stay above the ceiling when dosing for addiction. The first explains the ceiling effect and the second explains that it is at 4mg:




http://www.youtube.com/watch?v=lrqjJGoS ... er&list=UL

http://www.youtube.com/watch?v=Wqn5qDdp ... re=related

If they do not work just copy and paste them, I have never put a link on here and am not sure if I did it correctly.


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PostPosted: Sun Oct 02, 2011 12:05 pm 
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Thanks for posting those, breezy. I appreciate you taking the time to do that. You posted the links right. That's all you have to do is copy and past them in your reply. Nothing to it! Again, gracias!

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PostPosted: Sun Oct 02, 2011 12:20 pm 
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Thus was your last post in the "Stop telling us we take too much" thread, I thought it was apropriateto bring here with our current discussion. I am also going to copy the response I left. You have not commented there again so I am not sure you have seen my post.


Your Post

Lillyval wrote:
2mg is well below the ceiling and isn't even a therapeutic dose for most people. Even the prescribing info. states that 4mg is the miniumum dose (for maintenence). So anyone who is saying this to you doesn't understand how the medication works.


If this were true, why would buprenorphine be available for pain in .2, .4, and .8 pills? Temgesic? Hello??

Opiophile link (I can't add links due to forum rules but I will come back tmrw and add it)

All of these hardcore junkies doing bundles of heroin a day agree that bupe works better at low doses. When I'm on a computer instead of a phone I will post scientific studies backing low dose bupe.

Norbuprenorphine, which is what buprenorphine metabolizes into, is actually more "euphoric" than bupe itself. At more than 4 mg a day, your receptors are saturated and no norbuprenorphine can attach.

I have a question. Has anyone ever told all of you that "more works better" when they weren't making money from you/receiving kickbacks from RB?
Has anyone on generic subutex ever been told to stay at a ridiculously high dose?



My Post

What you posted above is the exact reason it is prescribed above the ceiling for addicts. You are correct in that below the ceiling it will give you more of an euphoric feeling and it works like a full agonist. This is what addicts are trying to avoid, which is why for maintenence for addiction it is prescribed above the ceiling. People in recovery no longer want the highs and lows and when above the ceiling and your receptors are saturated you just feel normal and can not get an euphoric effect. If taken the way you sugest below the ceiling where it is a pain med and you can get high from it then what is the point of an addict switching from oxy or hydro or whatever the case may be? Now they are just on another pain med that they can get the euphoria from. I am happy your low dose is working for you but I don't understand why you feel the need to tell those of us on higher doses that we are wrong and just being taken advantage of. I can assure you my Dr. gets no reward for prescribing his patients Suboxone, he has switched me to generic subutex. To be honest I am offended by your accusations, I can assure you I have done a lot of research and am not so weak minded to just throw my money away. I have experimented with my dose and at 16mg is where I feel the best and who are you to tell me otherwise? Temgesic is used on people who have no tolerance to opiates to treat pain. The doses you list below would be like giving an addict a hydrocodone and expecting them to stop withdrawing.


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PostPosted: Sun Oct 02, 2011 1:37 pm 
Hatmaker, I am surprised that as a moderator you don't know the rules of this forum. It wouldn't let me post any links because I hadn't been a member of the forum for at least 48 hours.

Okay, I thought we were talking about the ceiling effect. The dose at which buprenorphine blocks opiates is NOT the same as the ceiling effect. The ceiling effect is the dose at which no increase in effects can be felt anymore, to put it simply.

I will now try and post the response I tried but was not allowed to post before.


hatmaker510 wrote:
Ironic,

As I'm sure you're aware, Suboxone is a partial opiate agonist, as compared to full opiate agonists like oxy, methadone,
morphine, etc. And the ceiling effect is therefore also unique to Suboxone/Subutex. Dr. Junig has gone over this in detail many times in his blog and in his videos, but I'll give you a quick rundown again.

The "ceiling effect" occurs at or around 4 mg. At this point the receptors are saturated, but
not they are not STAYING saturated. For this reason (and this is all from Dr. Junig), people need to be dosed above 4 mg so that the receptors are KEPT SATURATED at all times. Add to that individual cravings and appropriate doses for people will vary from approximately 4 mg to 16 mg. This is for addiction only, not for the using sub for pain purposes.

Under 4 mg, there is no steady dose of bupe and the receptors are not saturated, therefore suboxone
can act more like a full agonist than the partial agonist that it is. Because their dose of bupe will go up and down, they might even feel their doses.


I hope this helps. Please do spend some time on Dr. Junig's old blog posts and videos. They are extremely informative.


That was a nicely worded explanation, but it simply isn't true.

The ceiling dose of bupe is ~32 mg.

Please look under "ceiling effect"
http://pb.rcpsych.org/content/29/6/225.full

This is definition of the term "ceiling"
http://www.stoppain.org/pain_medicine/c ... pioids.asp

Maybe you are confused about what "ceiling" means?


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PostPosted: Sun Oct 02, 2011 1:48 pm 
Breezy_Ann wrote:
Thus was your last post in the "Stop telling us we take too much" thread, I thought it was apropriateto bring here with our current discussion. I am also going to copy the response I left. You have not commented there again so I am not sure you have seen my post.


Your Post

Lillyval wrote:
2mg is well below the ceiling and isn't even a therapeutic dose for most people. Even the prescribing info. states that 4mg is the miniumum dose (for maintenence). So anyone who is saying this to you doesn't understand how the medication works.


If this were true, why would buprenorphine be available for pain in .2, .4, and .8 pills? Temgesic? Hello??

Opiophile link (I can't add links due to forum rules but I will come back tmrw and add it)

All of these hardcore junkies doing bundles of heroin a day agree that bupe works better at low doses. When I'm on a computer instead of a phone I will post scientific studies backing low dose bupe.

Norbuprenorphine, which is what buprenorphine metabolizes into, is actually more "euphoric" than bupe itself. At more than 4 mg a day, your receptors are saturated and no norbuprenorphine can attach.

I have a question. Has anyone ever told all of you that "more works better" when they weren't making money from you/receiving kickbacks from RB?
Has anyone on generic subutex ever been told to stay at a ridiculously high dose?



My Post

What you posted above is the exact reason it is prescribed above the ceiling for addicts. You are correct in that below the ceiling it will give you more of an euphoric feeling and it works like a full agonist. This is what addicts are trying to avoid, which is why for maintenence for addiction it is prescribed above the ceiling. People in recovery no longer want the highs and lows and when above the ceiling and your receptors are saturated you just feel normal and can not get an euphoric effect. If taken the way you sugest below the ceiling where it is a pain med and you can get high from it then what is the point of an addict switching from oxy or hydro or whatever the case may be? Now they are just on another pain med that they can get the euphoria from. I am happy your low dose is working for you but I don't understand why you feel the need to tell those of us on higher doses that we are wrong and just being taken advantage of. I can assure you my Dr. gets no reward for prescribing his patients Suboxone, he has switched me to generic subutex. To be honest I am offended by your accusations, I can assure you I have done a lot of research and am not so weak minded to just throw my money away. I have experimented with my dose and at 16mg is where I feel the best and who are you to tell me otherwise? Temgesic is used on people who have no tolerance to opiates to treat pain. The doses you list below would be like giving an addict a hydrocodone and expecting them to stop withdrawing.


I don't really know what you mean when you say "below the ceiling where it is a pain med and you can get high from it..."

I don't know anyone that gets high from buprenorphine. I certainly don't, and if you have a tolerance to opiates, no dose should get you "high." I don't know if you have ever used heroin, but it just isn't even close. It doesn't cause euphoria for anyone I have ever met, unless they were taking it while in severe withdrawal.

"The doses you list below would be like giving an addict a hydrocodone and expecting them to stop withdrawing." I don't know why you mention this. I didn't know we were discussing someone who was detoxing from a full-agonist. I am only talking about someone who is on ORT. I needed 8-12 mg per day while detoxing..that is totally different. After a week or so, you are no longer going to be detoxing from the full-agonist unless it is methadone.

Have you ever even tried to take a dose lower than >1 8 mg pill per day? What if you ever need surgery, or have a real medical need for full-agonist painkillers? At 16 mg per day I don't know how you would ever get pain relief from a full-agonist. I don't know about this, but I think doses that high could cause permanent damage to the receptors. Do you ever plan on getting off of Suboxone?

I took 2-4 mg per day for about a year, because I felt I needed to be on a blocking dose. Now that I have been clean for awhile, and don't desire to get high, it doesn't matter that I am not on a blocking dose. I am interested in eventually getting off bupe (it has been 14 months) because I KNOW that it is healthier to not be on it.

I am not telling anyone they are "wrong." Being "wrong" is a matter of opinion. I am just presenting a set of facts that really hit Reckitt Benckiser in the wallet.

How many people who feel they need so many mg per day have actually tried a lower dose? Not an immediate reduction. A slow taper down to a lower dose, trying it for a couple of weeks, and seeing how it works? Most people report that they feel just as much mental relief with less side effects..and I am not just talking about <2 mg. 2-4 mg are still blocking doses and they just won't fuck up your tolerance the same way 16 mg does.


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