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PostPosted: Sat May 07, 2011 11:17 pm 
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I've read posts here talking about how 1mg of Sub is like 10-20 times more potent than morphine, etc. Something to that degree and please post the correct numbers if you have them. I'm just too lazy to go back and look.

My question is: If Suboxone is really that strong, wouldn't a smaller dose, say .50 to 2mgs alleviate withdrawals symptoms from most opiate-heroin users? I just find it very confusing when the government states that 12-16mgs is a low to moderate dose used for maintenance. My nurse showed me that statement on my last appointment.

I do know it to be a strong drug because I can feel it, even at 6mg's. My doctor gave me three pills at my first induction (24mgs). Given the potency of it, maybe I should have been given much less. Like 2mgs?

Has anyone been given a low dose and not had withdrawals?

Just been thinking about this and would love some input if you have it.

Rule62


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PostPosted: Sun May 08, 2011 1:37 am 
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Ok, so buprenorphine (the active ingredient in Suboxone) is 20-40x's more potent than morphine...but only up to the "ceiling level." When talking about buprenorphine's potency, we're talking about it's analgesic strength. In low doses, bupe is 20-40 times stronger than morphine...but as the dose of buprenorphine goes up, the analgesic strength (or potency) levels off at around 4mgs, after which a higher dose of bupe isn't any more potent - it just lasts longer.

With a drug like morphine, you can keep ingesting more and more of it and it will continue to stimulate your opiate receptors in direct proportion to the amount of the drug consumed. It will also continue to depress respiration, risking overdose. With buperenorphine, the opiate receptors are only partially stimulated and you are only going to get so much of an effect from taking it - up to about 4mgs, after which taking more doesn't do much of anything until you get into VERY high doses. At really high doses (above 32mgs) bupe can make you feel sick in a way that is similar to withdrawals.

The most analgesic effect that you can get out of a dose of buprenorphine is equivalent to about 40mgs of morphine. So, 1mg of buperenorphine = 40mgs of morphine, 4mgs of bupe = 40mgs morphine, 8mgs bupe = 40mgs morphine. This is why people with a very high opiate tolerance, like someone with a large heroin habit or a high methadone dose, can have difficulty stabilizing on even a high dose of Suboxone when they first start treatment. For many addicts, an induction dose of 8-16mgs is PLENTY strong enough to allieviate withdrawal and cravings...but for those with sky-high tolerance, the first week or two is sometimes an adjustment while their tolerance comes down to a level that can be handled by Sub (bupe).

A smaller dose of Sub (bupe) would very likely be enough to handle the withdrawal/cravings of a lot of opiate addicts. The reasons that Sub is prescribed at higher doses have to do with maintaining a stable level of buprenorphine in the blood. The higher dose allows the medication to build up to a stable level in the addicts bloodstream, which prevents the cycle of ups and downs (the feeling of getting high and then subsequent withdrawal) that are the hallmark of addiction. A stable blood level also allows the patient to dose just once per day, which is an important factor in breaking the habit of dosing ourselves multiple times per day. So the higher dose keeps the opiate receptors occupied, keeping withdrawal and cravings (the obsession to use) away and breaks the pill-popping habit - all things that free us to get to work on recovery.

Of course, many Sub patients find that once they are stabilized on a regular dose that they are able to easily decrease their dose with little problem. I also know that the original dosing guidelines were based on the possibility of dosing every-other-day, and were subsequently higher. The dose guidelines have been revised at least once that I know of - I think they lowered the recommended maximum daily dose from 32mgs to 16mgs.

It is possible to be on a low dose for maintenance and not suffer withdrawals. I found that as long as my dose was 4mgs or higher, I could go 24 hours between doses without withdrawals. Any lower than 4mgs and I would start to feel withdrawals in the morning before my dose - but it was still really manageable. At 4mgs, for MOST people, all your opiate receptors are covered. Below 4mgs, you don't have full coverage. The lower your dose, the more you will be able to feel the fluxuations in your blood level.

Allright, sorry I wrote a damn book but I hope it helps.

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PostPosted: Sun May 08, 2011 3:59 pm 
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I think you cleared it up...I think. Funny thing is, I DO feel higher doses. Sub is supposed to keep you level and not high, but I get a buzz and then some if I take more. That has become a problem with me because when I get a new script for the month there are normally a few strips left over and I take them for the first few days until they're gone and then I'm back to my regular dose. It makes me feel a wired feel good about life buzz and it's a hard one NOT to do every month. I was fine for the first six months, then bam, I start this crazy addict behavior. Several of my good peeps here have been straight up with me about it and I will just not do it anymore if I ever plan on recovering. I hate being an addict...

Thanks for the post.


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PostPosted: Sun May 08, 2011 6:58 pm 
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Yes, thank you DOAQ. You are really knowledgeable. I'm serious. It's interesting to me what you said about the once daily dosing getting harder below 4 mg. I've noticed the same exact thing. I wanted to ask you something about your taper, if you don't mind. When you dropped to the lower doses, meaning 2 mg and less, did you seem to always be a little in w/d by your next dosing time? Did you start feeling some symptoms? I'm wondering if maybe beneath a certain amount, tapering gets different. At the higher doses, I adjusted to where I felt no symptoms when it was time to dose again. I'd be completely adjusted. This doesn't seem to be happening. I'm wondering if other people have a similar experience and I just don't know it.

Rule62, I think you are in the majority and not the minority. Many, many, many people take extra Sub if they have it to take. The only reason I did not do that was that my first doctor told me it would not make me high and would actually make me sick. I believed him, so I did not dare do it. If I thought I'd get buzzed from it, I would have taken extra. Absolutely!!! I do remember feeling like Sub gave me extra energy for a long time. That went on for months and months, but it did go away completely. Even if you are getting a little bump now I doubt it will happen 'forever'....whatever forever is. You can reel it back in and get it completely under control. Then, I'd suggest hoarding any that you have leftover.

laddertipper

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PostPosted: Sun May 08, 2011 8:53 pm 
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laddertipper wrote:
Yes, thank you DOAQ. You are really knowledgeable. I'm serious. It's interesting to me what you said about the once daily dosing getting harder below 4 mg. I've noticed the same exact thing. I wanted to ask you something about your taper, if you don't mind. When you dropped to the lower doses, meaning 2 mg and less, did you seem to always be a little in w/d by your next dosing time? Did you start feeling some symptoms? I'm wondering if maybe beneath a certain amount, tapering gets different. At the higher doses, I adjusted to where I felt no symptoms when it was time to dose again. I'd be completely adjusted. This doesn't seem to be happening. I'm wondering if other people have a similar experience and I just don't know it.

laddertipper


Yes, when I got down below 2mgs I would start to feel some withdrawals around my dosing time. And I could "feel" the dose more once I took it than I could when I was on a higher maintenance dose. It was more like a feeling of relief than a buzz though. I think at these really low level doses, it's just too hard to keep a stable level of Sub in your system.

When I would first make a reduction, I would feel crappy for a few days or maybe a week. By that I mean I felt pretty crappy all day. After I got used to the reduction, I would just feel the withdrawals when it was getting close to dose time. I also had to switch from once a day to twice a day dosing for a while...until my dose got so small that it was ridiculous to try to split it (I think around 0.3 mgs). The twice a day dose was what let me get some sleep. I would put that evening dose off as long as possible so I could take it closer to bedtime.

For some reason, insomnia is my biggest w/d symptom and it's the one I just can't handle, so I fooled around trying anything that would let me get a decent amount of sleep. Without sleep, I couldn't handle the achy-bitchiness, anxiety, etc. When I got down to the really tiny doses, I dosed in the morning and used clonidine to help me sleep.

Ladder, I'm sorry you're having such a hard time getting stable at 1mg. I don't know if I told you this already or not, but getting below 1mg was like the hardest thing for me. I don't know why - I was able to get down to 1mg without much fuss, but that was like the sticking point. I hope things are at least getting a little better for you. I know how tedious this process is and it sucks so much to feel like you're not getting anywhere - but you will get there!

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PostPosted: Thu May 12, 2011 10:22 pm 
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DOAQ and Laddertipper, some really great info from you both. Knowing what will happen getting down to below 2mgs is a help. I hate surprises. And I too am sorry LT for your crumby symptoms your having right now. Most likely my post will be similar when I get down to 1mg. But that's a few months off if I continue to go slow.

After you and Romeo warned me about taking more that the usual dose, I've been a good boy. Mostly had to chalk it up to being an addict again and realize I'll never recover if I don't stop that behavior. It'll be stockpiled for an emergency like you suggested.

I'm moving next month and once we're settled it'll be easier to wean down to a jumping point. You all know how stressful a move is so I'll stay a my 4mgs until all the dust has settled. Then recovery here I come.

Thanks to both of you.


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