refresh my memory subutex

[_Enduser]

etorphine would work! The packs come with naloxone because the ambulance can't get to you fast enough!

I think you should try it to prove to us just how big your ballz are

[Narkotikon]

As everyone else said, DO NOT take bupe (Suboxone, Subutex, Temgesic, Buprenex, Butrans) if you're physically dependent on full agonists. 

You'd have to be in w/d before you could take bupe.  If you do it while still felling the affects of a full agonist, it will cause precipitated w/d. 

The only exception I can think of is if you were taking sufentanil.  Sufentanil can displace bupe.  So if you are in precipitated w/d, you could take sufentanil and get back to normal.

OR you would die from an overdose
yea I'm thinking that is most likely
unless of course your drug of choice is sufentanil

HARM REDUCTION PEOPLE!

I meant it as an example, not a suggestion. 

Obviously a person shouldn't take sufentanil unless they're dependent on it.  And even then, preferably not outside of a hospital setting. 

[LoneRanger7]

Oh god  I got thrown into PWD's once, I couldn't have sat still on a train car! I was rolling around on the floor! Every nerve in my body was simultaneously thrumming in the worst possible way. This is weird but I felt like I was having orgasms but they didn't feel good although they did provide some relief, so weird. It was god-awful and I'd try nearly anything to avoid it in the future.

I don't remember the specifics but I know I took a sub strip the morning after several roxy 30s. I figured they were so fast acting I'd be fine. I guess sleeping over night slowed my metabolism enough that it wasn't all processed? I reversed it successfully by taking an 8mg subutex though.

[DeadCat]

Precipitated acute w/d is one of the worst feelings out there. Howvery youhave to be everyday depenedent on opiates to fall victim to them. I also suspect if you r "habit" is  a few viconin a day, it the PW won't be any worse that the most intense of your w/d when denyed your DOC.

If you do not have a habit and take buprenorphine too soon after taking an opiate you just get sober, you don't go into w/d bcause you weren't dependent to begin with.

If you are opiod dependent (need opiates to function normally) then you need to wait until you are ure you are in w/d before taking the buprenorphine. How much time you have wait depends on the "legs" of your DOC. Short cting opiates like oxycodone IDK, maybe 16 hours? Longer acting ones lik methadone I'd guess at least a day probably more like 36 hrs.

Wait as long as you can. And then wait some more. Wait until you are noticeably dopesick, like when people start asking you "are you OK" dopesick. And, start s mall just a couple mg to start then wait and see how you feel and after at lest an hour maybe 2 more.

PW is so bad that once you have had it you will have learned how important being careful is.

[Snoop]

I'd wait a HELL OF A LOT LONGER THAN 36 HOURS if I was transitioning from methadone to Bupe.

More like, shit..... 9 to 10 days. At least.

Good thing I do my homework too, cuz my first PM doc I was referred to wanted me to discontinue my MD for 48 hours before I started the Bupe he prescribed.

I been thru PWD once, I took some way too soon after a few Norco.

I can only imagine what would have happened if I followed that Quacks instructions.

Jesus Christ on a Cracker.... *shiver*

What kinda crash course are they sending these MD's thru?

Fucker could've killed me, or make me at least WISH I was dead.

[Griffin]

From what my counselor told me doctors are allowed to prescribe subs for pain, but to be able to prescribe it for opiate addiction they only have to do one 8 hour seminar, thats it. I can't imagine that you would be able to learn what is really needed to properly treat addiction in 8 hours. When I tried subs my doctor wasn't very knowledgeable I imagine thats the norm and that a lot of doctors are in it for the money.

 I would wait at least 3-4 days after coming off methadone before I even considered taking a sub and since I have had precipitated withdrawals I would probably wait 6-10 days before actually taking it.

I got precipitated withdrawals 32 hours after taking er morphine that I chewed up. It was my first appointment getting it prescribed to me and the doctor had the nurse do it. I got so sick and the nurse didn't know what to do and she couldn't get a hold of the doctor because he was in a conference. I called the doctor probably 30 times and he didn't call me back for 3 days I was so pissed.

The nurse prescribed me clonidine and xanax when I told her I couldn't stay in there any longer because the w/d was so horrible. I can't fathom that experience without comfort meds. The nurse just left me in there for 30 minutes after I had already started having precipitated withdrawals because she was trying to get a hold of the doctor and couldn't.

By far top 2 worst feelings I have ever experienced. I compare it to coming off 280 mg of done in jail. Precipitated w/d was far more intense, but what the methadone w/d lacked in intensity made up for in duration. I didn't feel right for a month and was still having w/d symptoms for 4 months till I got back on methadone.

I lost my insurance and my prescription for subs went from being free to $600 a month plus $125 for the appointment. I called my pharmacy and they told me if he writes for generic sublingual buprenorphine/naloxone it would be just over $100 for the script. He wouldn't write for anything except name brand suboxone, and I went off on him for it. I asked why can't you prescribe me generic buprenorphine/naloxone when you've been prescribing me the exact same thing just a name brand.

I went on to accuse him of being a money grubber taking kick backs from suboxone to prescribe their drug and that he was more concerned about being paid by their pharmaceutical company than helping me stay clean. I told him he was setting me up to go back on heroin and overdose and when I die from it, it will be on his money grubbing hands. I just think that goes against the Hippocratic oath.

Does anyone know why doctors would do this? It shouldn't be allowed, he didn't give me any explanation for it other than this it's his practice and thats how he runs it. He didn't say shit about them being more abusable or anything medically that would warrant not scripting generics that were $500 cheaper. My main guess is he got kick backs for customers.

That was in October of 2013 and they were switching to obamacare. If I wanted to continue my insurance I lost when I got fired it would of been $800 a month because I now have opiod addiction as a pre-existing condition. The cheapest insurance I found that covered suboxone was $500+. The prices obviously went down after Jan. 2014 but it still left me in limbo until then.

In all honesty it was one of the best things that ever happened to me because I couldn't get past 3 weeks clean time on subs. I was dead set on getting clean and really wanted it, but it did absolutely nothing for my cravings, anxiety, insomnia, and depression. I ended up selling most of them and having a huge habit. I would save half of my script and sell the other half for about $500-600 a month.

I was also making $65000 a year working for comcast. Which for a 22 year old with an opiate addiction that is way to much money. I was taking 5-10 oxy 30s 3-4x a day or 1-2 gs of dope when pills weren't around. When I switched over to MMT I had about 150 subs stashed for a rainy day, and then I got arrested 2 weeks after getting on MMT.

The girl I was living with at the time moved to another state and took all of them and everything I owned with her when I got arrested. When I got out of jail I had nothing but the clothes on my back and a one way bus ticket. I lost my car and apartment I was sharing with her, every single thing I owned literally, the cops took my phone and all of my money I had in my wallet for bond fees and such.

I have no family here, I couldn't leave the state, and I had lost my job 3 weeks earlier. Plus my bank account was closed because I had to many over drafts because I knew I was getting $2500 2x a month. So twice a month I would overdraft it by $400. When I got out all I had was a pair of jeans, a hoodie, and a t-shirt and that was every thing I owned. It was November to so it was snowing and I didn't get out of jail till 8:30 p.m.

I went to a friends house and thank god he was home and let me sleep there for the night and call my family. I hadn't talked to them since before I got arrested. They knew I was in jail, because the girl I was living with told them, but they were broke and couldn't put money on my books for me to call and let em know I was out or what happened.

It was a blessing in disguise though, methadone was a life saver. I have over 2 years clean and feel normal for once. I hardly ever have cravings, and I have had like 2 panic attacks since I got on MMT instead of 2 a day which is damn good considering all I have been through.

Plus I didn't know how to leave that girl sense she moved here with me. She would guilt trip me into not leaving her all the time because she made more money than me and supported me for years when I didn't do shit. I felt bad that I didn't want to date her, and I am so glad everyday that it is over and I got out of it.

So all around it was for the better, I mean if I could of just stayed on methadone, left her, and not got arrested my life would be about 100x better now but I try not to get into ifs, ands, and buts.

[corlene]

From what my counselor told me doctors are allowed to prescribe subs for pain, but to be able to prescribe it for opiate addiction they only have to do one 8 hour seminar, thats it. I can't imagine that you would be able to learn what is really needed to properly treat addiction in 8 hours. When I tried subs my doctor wasn't very knowledgeable I imagine thats the norm and that a lot of doctors are in it for the money.

 I would wait at least 3-4 days after coming off methadone before I even considered taking a sub and since I have had precipitated withdrawals I would probably wait 6-10 days before actually taking it.

I got precipitated withdrawals 32 hours after taking er morphine that I chewed up. It was my first appointment getting it prescribed to me and the doctor had the nurse do it. I got so sick and the nurse didn't know what to do and she couldn't get a hold of the doctor because he was in a conference. I called the doctor probably 30 times and he didn't call me back for 3 days I was so pissed.

The nurse prescribed me clonidine and xanax when I told her I couldn't stay in there any longer because the w/d was so horrible. I can't fathom that experience without comfort meds. The nurse just left me in there for 30 minutes after I had already started having precipitated withdrawals because she was trying to get a hold of the doctor and couldn't.

By far top 2 worst feelings I have ever experienced. I compare it to coming off 280 mg of done in jail. Precipitated w/d was far more intense, but what the methadone w/d lacked in intensity made up for in duration. I didn't feel right for a month and was still having w/d symptoms for 4 months till I got back on methadone.

I lost my insurance and my prescription for subs went from being free to $600 a month plus $125 for the appointment. I called my pharmacy and they told me if he writes for generic sublingual buprenorphine/naloxone it would be just over $100 for the script. He wouldn't write for anything except name brand suboxone, and I went off on him for it. I asked why can't you prescribe me generic buprenorphine/naloxone when you've been prescribing me the exact same thing just a name brand.

I went on to accuse him of being a money grubber taking kick backs from suboxone to prescribe their drug and that he was more concerned about being paid by their pharmaceutical company than helping me stay clean. I told him he was setting me up to go back on heroin and overdose and when I die from it, it will be on his money grubbing hands. I just think that goes against the Hippocratic oath.

Does anyone know why doctors would do this? It shouldn't be allowed, he didn't give me any explanation for it other than this it's his practice and thats how he runs it. He didn't say shit about them being more abusable or anything medically that would warrant not scripting generics that were $500 cheaper. My main guess is he got kick backs for customers.

That was in October of 2013 and they were switching to obamacare. If I wanted to continue my insurance I lost when I got fired it would of been $800 a month because I now have opiod addiction as a pre-existing condition. The cheapest insurance I found that covered suboxone was $500+. The prices obviously went down after Jan. 2014 but it still left me in limbo until then.

In all honesty it was one of the best things that ever happened to me because I couldn't get past 3 weeks clean time on subs. I was dead set on getting clean and really wanted it, but it did absolutely nothing for my cravings, anxiety, insomnia, and depression. I ended up selling most of them and having a huge habit. I would save half of my script and sell the other half for about $500-600 a month.

I was also making $65000 a year working for comcast. Which for a 22 year old with an opiate addiction that is way to much money. I was taking 5-10 oxy 30s 3-4x a day or 1-2 gs of dope when pills weren't around. When I switched over to MMT I had about 150 subs stashed for a rainy day, and then I got arrested 2 weeks after getting on MMT.

The girl I was living with at the time moved to another state and took all of them and everything I owned with her when I got arrested. When I got out of jail I had nothing but the clothes on my back and a one way bus ticket. I lost my car and apartment I was sharing with her, every single thing I owned literally, the cops took my phone and all of my money I had in my wallet for bond fees and such.

I have no family here, I couldn't leave the state, and I had lost my job 3 weeks earlier. Plus my bank account was closed because I had to many over drafts because I knew I was getting $2500 2x a month. So twice a month I would overdraft it by $400. When I got out all I had was a pair of jeans, a hoodie, and a t-shirt and that was every thing I owned. It was November to so it was snowing and I didn't get out of jail till 8:30 p.m.

I went to a friends house and thank god he was home and let me sleep there for the night and call my family. I hadn't talked to them since before I got arrested. They knew I was in jail, because the girl I was living with told them, but they were broke and couldn't put money on my books for me to call and let em know I was out or what happened.

It was a blessing in disguise though, methadone was a life saver. I have over 2 years clean and feel normal for once. I hardly ever have cravings, and I have had like 2 panic attacks since I got on MMT instead of 2 a day which is damn good considering all I have been through.

Plus I didn't know how to leave that girl sense she moved here with me. She would guilt trip me into not leaving her all the time because she made more money than me and supported me for years when I didn't do shit. I felt bad that I didn't want to date her, and I am so glad everyday that it is over and I got out of it.

So all around it was for the better, I mean if I could of just stayed on methadone, left her, and not got arrested my life would be about 100x better now but I try not to get into ifs, ands, and buts.

The script for pain must state it is for pain management or they need to take the 8 hour course.  Which gives them a different letter to start the dea numbers.

[Snout]

The first time I took bupe to kick was in 2004. I was on 80mg methadone for 9 months and the sub doctor told me to wait 24 hours after my last dose. The PW was hellacious , I didn't know about receptors and agonists and antagonists back then, I thought I was having an allergic reaction to the subutex and I thought I was going to die. Could not even hold myself over the toilet, just lying on bathroom floor in a pool of vomit. My lovely non using girlfriend flipped out.
     The doctor was the "kick dr." In beacon hill in seAttle. He practiced mon to Thursday ,noon to 2pm. I won't mention the quacks name, anyone know who I mean?

[Anti-hero]

I don't Like subs at all
They do fucked all but keep you from being sick
And block everything
I don't them when I can
Because I am tried of this

You can get out of pwds
If you keep dosing
I don't know why the sub doctor
Or nurse didn't know this

It it's a money scam
They got a lock on it
Just like oxy

[DeadCat]

IIRC Subs are Schedule 2 and can be writtn by ANY doctor "off label" or if s/he fels they woud be "good medicine" for whatever complaint the patient presents. Once they take the 8 hour class they can then write to treat opiate dependence.

However that class must be about as intensive as making them watch a video for a bout 8 hours and of my 6+ buprenorphine doctors more than half don''t really know how to best use them. For instance, I tried to explain to my current doctor that subingual dosing doesn't give 100% bioavailability (only about 35%) and can vary with dry mouth or excessive salivation or making a simple mistake like havinga glass of water before it is completely dissolved. He said it is ALL absorbed "directly" into the veins under your tongue. I didn't tell him that by IM'ng themI can use about 3X less.

Later I found a study showing IM and IV s close to 100% whie sub-lingual is only about 35% but sisn't bother showing it to him because if I proved hi wrong I was afraid he wouldn't take it well and might react by cutting off my bentos. I've had that happen.

In fact, the first sub Dr. I used when I moved back here, would make me take a UA every time I disagreed with him about something and chargd me an extra $20 for the privilege. One time I had surgery and Hydromorphine was prescribd for post-operative pain. The next time I went to  see him (the sub dr) he had a printout of all my prescriptions with the hydroorphine (Dilaudid) highlighted and accused me of "using." I told him that I had informed the surgeopn I was taking buprenorphine and according to my "contract' I only have to tell one of the 2 prscribing doctors (the sub doc or the surgeon) that I was taking bupe. That in fact is th law here.

I eneded up firing him after he cut of my Xanax cold turkey with no explanation. Then I did some research and found out he had be censured by the state board for trading opiates for sex with a patient. I think a great many of the doctors whoget the license to prescribe buprnorphne fordependence do so JUST to get more boost their "revenue stream" and typicaly they cahrge MORE per visit for"Suboxone Patients" which is discriminatory, punative and judgemental against opiate users.

Also if you can, get SUBUTEX or generic buprenorphine instad of th Suboxone or generic equivilant. The best reason to tell the doctor you need it is you get headaches shortly after taking the Suboxone. This is not uncommon and the protocol is to switch youto straight buprenorphine. The whole Bupe+Narcan mixture is just a scam by Reckitt Benckiser to get a patent and charge more.

[robojunkie]

First of all as everyone has said ABSOLUTELY DO NOT DO THIS!

That being said, even just being sick, especially with methadone, does not necessarily preclude the dreaded PWD's from coming.   If on a high dose and sick and off for three days and take subs of either type you will precipitate WD.  I did switching over.  Enough opiate has to be out of your system such that the minute fraction of "activity" (I just call this relative opiate strength/binding constant) of the partial is enough that the few remaining covered receptors being uncovered is made up for by the large scale binding of the buprenorphine.

And that being said, and this is NOT RECOMMENDED for really anyone, but I have intentionally induced the PWD's to rapid drop tolerance.  On a not to long ago short fentanyl run that got out of hand I dosed up of clonidines, benzos, gabapentin, amitryptiliine and a couple other things and as soon as I felt a little off took a strip.  Yes pure hell, even with all the "comfort" drugs, but within a day I was able to feel OK, two days I could function.  And this had spiraled to a near "infinite tolerance" incredibly quickly, less than ten days (wtf???). 

And just for the record, regular fentanyl has no problem cutting right through buprenorphine like a hot knife through puppy shit.  On 4 mg bid I could shoot through that easy with about 4-5 mg fentanyl.  Bupeprenorphine is a weird drug, on maintenance even when I cut down to like 1.5-2 mg bid I can't feel shit even if I double it, but if I have had a small dope habit and gone 24 hours, I once shot about a milligram of this kid's subutex and actually got a really good hit off of it.  In fact it was better than what I did in prison, also 1 mg but sniffed, with no tolerance or habit of any kind anymore.

But last thing absolutely do not mix those two things unless you are purposely trying to rapid detox and can take the pain.  The precipitated withdrawals are subjectively different than regular dope sickness.  Far more intense and "aggressive" for lack of a better work.  I never scream or yell or make hellish sounding screeches while dope sick, in PWD on the other hand...but the worst ends within 12 hours.  Somewhere around then you start to notice the feeling that your body is being ripped apart subsiding and its because you've shocked your brain into up regulating MORs as fast as humanly possible, not because of the buprenophine leaving.  After all, its half life is longer than any regular opioid with exception of methadone.  If you redose with subs at that point no increase in PWD, there is an actual decrease.  Depending on how high the tolerance was and how much you take, it may end it outright.

Regardless I think its best use is as a future RC precursor, by putting on an ethyl formate group on the phenolic OH, cyanogen bromide'ing off the cyclopropyl methyl group (enemy of all good opioid lovers, unless you're not breathing), and methylation of the "nor-bupe" via many different tried and true methods and subsequent removal of the carbonate ester.  That would be a long asss half-life version of dihydroetorphine.  Every one of those steps I've thought through in prison, and every one of those steps I have found done since then in some paper or another.  So it is actually a realistic thing.  I used to always wonder if the cyanogen bromide would dealkylate the cylcopropylmethyl preferentially or at all as it is usually only good for demethylation of a N-methyl nitrogen, but with the fixed locked rings being what they are I had always wondered what it would do with the electron poor methylene atom of the CPM group.  Someone else already had found out, and it was only like two or three years ago.  Technically I think this would even be legal as long as some addiction study is performed on one's pet mice and so forth...

[Opus]

The first time I took bupe to kick was in 2004. I was on 80mg methadone for 9 months and the sub doctor told me to wait 24 hours after my last dose. The PW was hellacious , I didn't know about receptors and agonists and antagonists back then, I thought I was having an allergic reaction to the subutex and I thought I was going to die. Could not even hold myself over the toilet, just lying on bathroom floor in a pool of vomit. My lovely non using girlfriend flipped out.
     The doctor was the "kick dr." In beacon hill in seAttle. He practiced mon to Thursday ,noon to 2pm. I won't mention the quacks name, anyone know who I mean?

I'm pretty sure I don't have the spelling right, do you mean Dr. Si? (Sy?)

I copped in his waiting room with my dad sitting there. Some dude was waiting nodding hard, I was sick as fuck and talked him into selling me a little like $6 piece while smoking outside. Booted it when I got home and I was glad I asked!

[corlene]

Glad I'm not the only one who has copped in doctors waiting areas.

[Snout]

The first time I took bupe to kick was in 2004. I was on 80mg methadone for 9 months and the sub doctor told me to wait 24 hours after my last dose. The PW was hellacious , I didn't know about receptors and agonists and antagonists back then, I thought I was having an allergic reaction to the subutex and I thought I was going to die. Could not even hold myself over the toilet, just lying on bathroom floor in a pool of vomit. My lovely non using girlfriend flipped out.
     The doctor was the "kick dr." In beacon hill in seAttle. He practiced mon to Thursday ,noon to 2pm. I won't mention the quacks name, anyone know who I mean?

I'm pretty sure I don't have the spelling right, do you mean Dr. Si? (Sy?)

I copped in his waiting room with my dad sitting there. Some dude was waiting nodding hard, I was sick as fuck and talked him into selling me a little like $6 piece while smoking outside. Booted it when I got home and I was glad I asked!

We have a winner! I heart you chops!