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PostPosted: Tue Sep 27, 2016 7:56 pm 
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I have heard many people who say that (A) they have high opioid tolerances (or used to anyways) and (B) cannot even really tell that they are on suboxone/cannot tell a difference after they take their dose. Well, for me....I CAN feel my doses....almost every one. First off, I used to have a ridiculously high tolerance in active addiction. Secondly, I have been on suboxone for over 5 years. I take 8 mg per day, I sometimes feel a somewhat strong effect from the medicine and other times it is rather mild. However, I do not understand why....I MUST be over the ceiling with years of it build up in my system....it is almost as though my body metabolizes it faster now than ever before. Can anyone relate to this at all?


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PostPosted: Wed Sep 28, 2016 12:32 pm 
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Buprenorphine does not build up over years. It takes about a week or two to get to 'steady state' where there is an equilibrium between buprenorphine in the blood, in the brain, or bound to proteins in other tissues. But all living parts of the body are constantly perfused by blood or plasma flow, so there are no places for buprenorphine to build up over time.

I don't know why you continue to 'feel' each dose; that is unusual. Especially early in treatment people will feel 'better' after dosing, but they eventually realize that the effect is mostly if not all a placebo response. For example, people will feel 'better' right away, within 20 minutes, when it takes an hour or two for blood and brain levels to increase after dosing.

Fast metabolizers of buprenorphine are uncommon. Buprenorphine does bind to proteins (again, a process that reaches steady-state within a week or two), and that binding limits the amount of each dose that gets to the liver, providing buprenorphine is being dosed properly and not swallowed. I would suggest, if it is causing problems, that your doc orders peak and trough blood levels of buprenorphine, and then you will have a better sense of what's going on.


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PostPosted: Wed Sep 28, 2016 2:51 pm 
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I had a similar experience when on 8 mg. My daily dose started at 16 mg and currently I am alternating between 2 mg and 1.5 mg a day. When my dose reached 8 mg I felt a distinct opiate high about 2 hours after dosing. When I was on 4-6 mg I would experience a much subtler high once in a while. At doses lower than 4 mg or higher than 8 mg, I have never felt any high or intoxication. Really weird that there was something different about 8 mg dosing for me.


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PostPosted: Sat Oct 01, 2016 1:28 pm 
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I first want to thank both of you for your replies. Jeandianne, I too am on 8mg per day. That is strange enough....but to make it even stranger, I too feel the opioid effect after about 1 to 2 hours....normally it peaks at about 3 hours....I feel it starting at about 40 minutes to 1 hour and then it increases in intensity until about 3 hours have passed.

Dr. Junig -a little background about me. First, I take my 8mg at night. I split the strip in half and put one piece on each side of my tongue. Second, I leave the medicine in my mouth for 2 hours. Sounds extreme, but that is what I have done for a long time....years. Third, I am obese and am about 100 pounds overweight (but very handsome and funny :P). Fourth, I am right on the line of being anemic (iron deficiency type of anemia). Fifth, I can sleep for 17 or 18 hours at a time if I just let myself sleep. Sixth, I do not smoke cigarettes or use any other substances other than suboxone. Seventh, I take Prozac (40 mg) every day...normally in the morning around 9 AM. Lastly, I sometimes either forget or do not have time to take my suboxone. For example, I fell asleep Thursday night and didn't take it....then Friday, it was too late and I just went to bed. I normally take it every day, but it is not uncommon for me to miss a day here and there. Once in a great while, I will miss two days in a row and only like 1 or 2 times ever have I missed 3 or more days in a row. I have been on this for 5 years and my dose has changed many times.

I can't really describe the feeling....it is not a high per se and it does not impair me. But it feels almost like what either (A) 5-10mg of hydrocodone feels like to a person with no tolerance or (B) what 15-20mg of oxycodone feels like to someone with a moderate tolerance or (C) 40-50mg of oxycodone feels like to a person with a heavy/major tolerance....but that is if you took away most of the euphoria and just made it a pure body buzz with only about 20% of the euphoria actually left. I am not trying to get all into a drug discussion here...just trying to explain it the best I can!

I KNOW that this is NOT psychosomatic for four main reasons, Dr. Junig:

1. It doesn't happen every time I take my medicine...but intermittently and unpredictably.
2. I have opioid-induced physiological symptoms that co-occur with the "buzz" such as extremely pinned pupils, itchiness, reduced ability to feel sexual stimulation/climax, nausea (rare), numbness feeling throughout my body and sometimes even minor swallowing issues and urinating issues.
3. It doesn't occur after 20-30 minutes...it occurs after an hour or two -which would be logical if what I am feeling is really caused by the dose of buprenorphine.
4. It happens to different degrees of intensity and is intensified when I take a dose after having missed it for a few days.


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PostPosted: Sat Oct 01, 2016 2:45 pm 
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It just happens to you at your current dose. Manufacturer suggests that after a year many patients can maintain on 4 mg a day. Maybe decreasing to 6 or even 4 mg would work better for you. It might get rid of your feelings of intoxication. If it doesn't bother you to feel high, you could leave things as they are and enjoy. There are times when I wish that I could increase to 8 mg just chasing the high, but my overall goal is to taper completely off so I continue with a slow taper. Best luck.


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PostPosted: Sun Oct 16, 2016 7:04 pm 
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I would look at things that have changed since you started experiencing these effects. Have you started any new medications or quit or resumed smoking cigarettes? Have you been drinking more alcohol?

Things like that can influence rates of metabolism, and usually the effects vary from individual to individual.

I do agree that occasionally I experience more subjective effects from Suboxone than other days. Maybe there's some slight variability in how much buprenorphine is in our strips from time to time?


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PostPosted: Mon Oct 17, 2016 4:36 pm 
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For me personally after being on maintenance w both methadone and sub, in order for it to work as a maintenance anti addiction drug (not necessarily detox), I have to "feel it" or experience its effects noticeably to some degree for it to work. If I didn't even notice I was taking anything I'd quit taking it. That Is what keeps my cravings in check and keeps me from relapsing to another opiate. Its A) legal keeping me from breaking the law to get it. B)its supervisedly available and consistent keeping me out if the usually illegal and destructive circle of obtaining it. C) In a structured supervised regimen it keeps it from being destructive and actually very constructive. Its no longer a dysfunction putting me at risk and harming others but is actually neutralizing and perpetually solving a potentially deadly and dangerous problem. No harm comes from it. There's a difference between simply not being in physical withdrawal which is attainable with (not so)simple abstinence(post detox), and active medication along with utilizing a program of consistent, structured, predictable, opioid assisted treatment that enables me to be free of craving of the hugely(history proven) destructive cycle, and allows me to avert my all consumed attention to healthy life living things. After losing almost a combined decade of life incarcerated all relating to and revolving around opiods and the attainment thereof, its safe to say its effective and warranted.


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PostPosted: Mon Oct 17, 2016 11:45 pm 
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It would be nice if I could feel my dose. But given I take the same dose once a day every day, I don't have that luxury. It just stops me from feeling sick. Only real benefits are craving management, and it maintains a low level tolerance that will minimise risk of mortality if I do actually relapse.

No "buzz" here sadly.


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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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