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PostPosted: Tue Jan 17, 2012 4:48 pm 
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I know that converting dose equivalents is not all that accurate... however.. I was wondering if someone could give me a ball park conversion of how much 4mg Bupenorphine is to morphine equivalents.
Thanks in advance,
Anita

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PostPosted: Tue Jan 17, 2012 9:51 pm 
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I was told by someone on here you can't make a conversion but I got this conversion chart from a advocate at my clinic early on.

#Pain Killer Equivalent Doses (Oral)
1.2mg.............Buprenorphine (Bupe)
200mg............Codeine (Tylenol 2, 3, 4, etc)
30-60mg.........Diacetylmorphine (Heroin) (orally it = morphine, IV/IM/insuffilated it's 2x as strong)
100mg............Dihydrocodeine
30mg..............Hydrocodone (Vicodin, Lorcet, etc)
7.5mg.............Hydromorphone (Dilaudid)
4mg................Levorphanol (Dromoran)
300mg............Meperidine (Demerol)
10-20mg.........Methadone
30-60mg.........Morphine
20mg..............Oxycodone (Oxycontin, Percocet)
10mg..............Oxymorphone (Numorphan)
200-300mg.....Propoxyphene (Darvocet)
150mg............Tramadol (Ultram, Ultracet)

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PostPosted: Tue Jan 17, 2012 11:32 pm 
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Finally a chance,

Thanks for this chart. I"m assuming this is for 4 mg- correct? Even if it isn't that accurate, I like having the perspective, given that the highest dose of MS Contin I was on was 40 mg a day and then Methadone was 5 mg 3x a day. My history is complicated and most people know it by now, but I was one of those that was put on it when I was on a real low dose of opiates, and likely should have ridden out the w/d. But now that the taper is going well, that is all very old news..

Anita

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PostPosted: Tue Jan 24, 2012 1:04 am 
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Hi Anita.

I think the chart means that each of those doses are equivalent as each other. So 1.2mg buprenorphine has the same narcotic effect as 30-60mg morphine. Many years back I saw an opioid naive guy take maybe 2mg buprenorphine, and was incredibly stoned and ill. So the table makes sense to me. So 4mg would be equivalent to around 100-200mg morphine? It's a bit vague I know.

I was also once concerned about being on too high a dose. I had a mild heroin habit as a teen. I went on 4mg bupe, mainly to get an easy buzz. I still think that allowing myself to adjust to the high dose was bad for my recovery. I stayed on it because I loved how it made me feel, instead of telling my doc I was feeling stoned and him reducing my dose. My cravings to use opioids were stronger after I tapered off the Subutex than before I went on it. So I think it's important not to push our tolerance to opioids higher while on replacement therapy.


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PostPosted: Tue Jan 24, 2012 7:40 pm 
Gday,
According to Dr J in his discussion on Pain Management, once you reach the “Suboxone ceiling"
(( your 99% there at 4 mg’s))
your opiate tolerance is equal to about 60 mg’s Oxy or 90 mgs of Morphine and because of Suboxone’s static tolerance it doesn’t change over time. So, whether you’re on 8 mg’s or 32 mg’s for 2 months or 2 years it doesn’t change. Of course when dealing with pain management there’s other things to consider like the stacking effect and the high receptor affinity of Bup, but as far as tolerance goes I think he pretty much answers your question.
Cheers, Subie


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PostPosted: Wed Jan 25, 2012 10:51 am 
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Subie is right. According to Dr. J, 4 mg of suboxone is equivalent to about 20-30 mg of methadone. Once above the 4 mg ceiling, you can't do a linear conversion. It's all the same above that ceiling mark.

Good answer, subie.

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PostPosted: Thu Jan 26, 2012 12:29 am 
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Either I've misunderstood Dr. J was saying, or something doesn't add up.

Correct me if I'm wrong. Sub lasts 24 hours. Morphine lasts 6 hours. A person would need more than one dose of morphine over 24 hours to match the duration of Sub. At least two or three 90mg doses. So 4mg sub would be like taking more like 200-300mg over 24 hours?

It was always really ambiguous to me.


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PostPosted: Thu Jan 26, 2012 4:41 am 
tearj3rker wrote:
Either I've misunderstood Dr. J was saying, or something doesn't add up.

Correct me if I'm wrong. Sub lasts 24 hours. Morphine lasts 6 hours. A person would need more than one dose of morphine over 24 hours to match the duration of Sub. At least two or three 90mg doses. So 4mg sub would be like taking more like 200-300mg over 24 hours?

It was always really ambiguous to me.


Gday, Tearj3rker
Hope your enjoying yr Australia Day

I’m certainly no expert on this stuff but Dr J definitely meant 90 mg’s of morphine spread over 24 hours. He actually uses oxy in his comparison (20mg’s of Oxy three times a day) then later coverts that to Morphine. The quotes below are from his “User Guide to Suboxone” and one of his blogs.
Seeya mate
Subie

“The second problem for a person on buprenorphine is his/her high opiate
tolerance, maybe as high as or even higher than the tolerance at the start of treatment with Suboxone. The tolerance from Suboxone does not change over time, but rather stays around the level of tolerance caused by 30 to 40 mg of methadone per day. That tolerance is about equal to 60 mg of oxycodone per
day. So in the post‐op patient having pain, even if we could remove all of the buprenorphine, tolerance will be such that it will take 20 mg of OxyContin three times per day just to break even and prevent withdrawal.”

“I use one of the opiate conversion calculators online to come up with the dose of morphine, fentanyl, or whatever PCA drug the surgeon prefers, and I recommend setting the baseline infusion at about 75% of the dose required to provide the equivalent of 60 mg of oxycodone spread over a 24‐hour period. This sounds more complicated than it really is‐‐ to
run through the math, I use the online opiate converter to convert 60 mg of oxycodone to a certain dose of morphine (my calculator says 90 mg of morphine equals 60 mg of oxycodone). I take 75% of this number and get about 68 mg of morphine. I then spread this amount over 24 hours, to get a basal infusion of about 3 mg of morphine per hour. This baseline infusion is intended to provide for the patients high opiate tolerance. I then recommend that the push‐button dose of narcotic be set to about twice the normal dose for a person of equivalent age and size.”

“The problem with buprenorphine is that the ‘ceiling effect’ occurs at a relatively high tolerance level, approximately equal to 40 mg of methadone. That causes at least two problems. First, going off Suboxone is a lot of work, as the person still has a great deal of withdrawal to go through. That may be a good thing early in the process, as it may help keep people on Suboxone, but after a year or so, when people want to try going off the medication, it is a major barrier that opens the floodgates to those old memories of using etched in the emotions associated with withdrawa
l.”


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PostPosted: Thu Jan 26, 2012 7:55 am 
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Subie pretty much answered it just as I was going to, if not better than I would have.

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PostPosted: Thu Jan 26, 2012 7:52 pm 
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Thanks for that Subie.

Straya Day! National glassin day.


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PostPosted: Tue Feb 19, 2013 9:10 am 
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Sorry. I no this thread is probably closed. But I gotta reply because this is misinforming. Suboxone's ceiling dose is not no 4mg's :lol: it is 24mg's so were ever DR.J got his info is wrong suboxone stops working at 24 all receptors are full bupe has one of they highest biding rates there's CT scans of the brain starting at 4mg 8mg 16mg and 24mg and 32mg's and at 32mg's there's no change in receptors they are complete full. And dose wise bupe is a very potent opiod 8mg suboxone/subutex equalis 100mg morphine. In my case I take 8mg's twice daily and some days I only take one 8mg film because the half-life is so long but when I have dental work like a tooth pulled. I get two to two and a half 8mg hydromorophone po twice daily. Not trying to be a mr. no it all but people should no when info is misleading do a basic google search and you can see the ct scan charts and opiate conversion charts.


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PostPosted: Tue Feb 19, 2013 9:21 am 
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The ceiling effect refers the dose at which the highest "opiate effect" is felt, and adding more will not change the effect. The way you feel at 4-8mg is the same way you feel at 24mg, regardless of whether all the receptors are occupied or not.

The ceiling effect is NOT the dose at which all the receptors are filled.


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PostPosted: Wed Feb 20, 2013 12:44 pm 
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That sounds about right 1mg sub to 30-60mg morph. Morphine really is a huge waste of time unless you have a gallon of it in a jug next to your bed. It wears off soo incredibly fast theres really no point in taking it. For me after surgery the nurse would give morphine and 5-10 minutes later it wore off. Now I back in pain and craving more opiates. Morphine was used in civil war battlefuelds and has no place in modern medicine. Eventually I refused the morphine and demanded dilaudid. About twice the strength at least and would last over an hour for me. The best part of subs for pain is you only take it once or twice daily. The effects stay with you and no cravings every hour. Some drs still think morphine is strong medicine. Tell them they living in the stone ages with that mentality. Would rather have 10mg oxy than any amount of morph.


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