Tramadol vs. Bupe

[PhoenixRisen]

This post will in no way be comprehensive, but rather an abstract from a gov't site, lazily copied, lazily pasted...


Department of Medicine, Huron Hospital, 13591 Terrace Road, E Cleveland, OH 44112, USA.
Various drugs have been used for the treatment of opioid withdrawal, e.g., methadone, buprenorphine, and clonidine. Tramadol is a centrally acting synthetic analgesic agent with opiate activity due to low affinity binding of the parent compound and higher affinity binding of the O-demethylated metabolite M1 to mu opioid receptors. As a consequence, there may be a role for the use of tramadol in the treatment of opiate withdrawal. We attempt to assess the efficacy of tramadol in treating moderate heroin withdrawal through a retrospective cohort control study, conducted in a detoxification unit in a community teaching hospital. Out of 100 heroin abusers admitted for detoxification during the review period, 64 patients who were treated either with buprenorphine or tramadol, were included in this study, with 20 participants in the buprenorphine group and 44 in the tramadol group. Both groups were matched for age, sex, and self-reported average quantity of heroin used per day. In the tramadol group, the average CINA maximum was 9.0, and in the buprenorphine group it was 11.2 (P = 0.07). The use of oral clonidine per patient in the tramadol group was 1.6 tablets, and in the buprenorphine group 0.1 tablets (P = 0.002). The length of stay was 3.7 days in the tramadol group and 4.1 days in the buprenorphine group (P = 0.5). Four participants in the tramadol group received three or more doses of buprenorphine because their symptoms were not controlled, and were considered as treatment failures. These preliminary data suggest that tramadol may be comparable to buprenorphine in the management of mild to moderately severe heroin withdrawal. These findings, if reproduced in larger studies with stronger research designs, have potentially great implications for the management of opioid withdrawal in both the inpatient and outpatient setting.



(The first thing I thought was... Heroin Detox and only tramadol? What a world of hurt... but my DOC's Morphine and I've been able to maintain..)

Don't know if I'd detox in a "teaching hosptial" though.

[limitless_euphoria]

(The first thing I thought was... Heroin Detox and only tramadol? What a world of hurt... but my DOC's Morphine and I've been able to maintain..)

Don't know if I'd detox in a "teaching hosptial" though.

As far as detox in my view, I would say methadone would be the best if you use a whole shit-ton of H each day. If I had my way, and if I could have gotten in, I would have done a methadone detox way back when I had a huge-ass monkey on my back. But, at the places I tried to get in, I kept getting trumped by OD cases or people who prearranged it with their doctor.

Bupe is good if you're beyond light use but not too, too heavy. I had to settle on it because it was bupe or nothing at the time when I kicked. It really didn't start helping until about day 4 or 5--I was that bad off.

Last but not least, if I were trying to kick a habit of say a few bags of dope a day or vikes or percs, maybe then would I use tramadol.

As for long-term maintenence bupe definitely wins. If I were in serious pain, then methadone would win. Trams just aren't strong enough to stave off cravings for me and I would end up taking too many or clock-watching for when I could pop the next one.

[HydroApe]

I have a faily large daily morphine (180mg) and Oxy (70mg) habit. Well, maybe not large for some but nothing to sneeze at.

If and when I ever run out I keep trams on hand. Granted, I get nada out of them, no buzz and no pain relief. However, 250mg a day keeps me completely withdrawl free except perhaps some lethargy/depression. Main point is that I can go to work just fine. The only reason I throw this out there is in case someone has never utilized them to help themselves.

[Kicks]

In my experience, tramadol doesn't do shit for withdrawals if you have a moderate tolerance or greater, but it can alleviate withdrawal if you have a mild habit.

I tried this long before reading that tramadol could possibly help opiate withdrawal. I knew tramadol was some kind of bastardized opioid, and had some minor affinity for the μ-opioid receptor, so my thinking went something like, "Fuck it, why not? I'm out of dope and got nothing to lose."

The first time I tried it was about a month after I started using heroin everyday. My habit, if you could even call it one, was one to two bags a day. I was visiting my parents on vacation and had purposely brought only a few bags, with the intention of running out. The day after my last dose, I had some very minor withdrawal symptoms, namely, mild hot-and-cold flashes and sweats, insomnia, and some restlessness. (Thinking of that as withdrawal is laughable now—the foolish naïveté of a novice junky!) After rooting around the medicine cabinet, I found an old prescription of Ultram. I was somewhat familiar with its effects, having taken it a couple times in high school in a pathetic—and ultimately futile—attempt to get high. If I recall correctly, it took 150 mg to eliminate withdrawals and make me feel a hundred percent.

The second time I used tramadol for withdrawals was a few months later. My habit had increased to three to four bags a day, still relatively small. This time it took around 250–300 mg to get well. At that point, I thought I'd discovered an invaluable tool for dope droughts. I should also mention that I just used the tramadol until I could get my hands on more diesel, which, both times, was less than a week.

However, by the next time I would try it again, my habit had increased to a bundle a day. I took about 400 mg of tramadol but found it had no noticeable effect on my withdrawal symptoms. I did try it a couple more times after that, but found it to be ineffective both times.

Conversely, buprenorphine is able to stave off the withdrawals of a bundle per day habit for me. On the first two days of switching to bupe, I need 16 mg to eliminate withdrawal symptoms. After that, to keep withdrawals at bay, I need about 4 mg per day (insufflated). Interestingly, I've found that bupe and tramadol feel remarkably similar when using it for detox purposes; both are somewhat stimulating, providing an energetic feeling, but have little euphoria.

Thus, from my experiences, I have concluded that tramadol is only effective at eliminating withdrawals if one has a relatively small habit. My conjecture, regarding the abstract in the original post, is that the greater average amount of clonidine consumed by the tramadol group (1.6 tablets versus the bupe group's average of 0.1 tablets) is largely responsible for alleviating their withdrawal symptoms.

Comparing the relative values of tramadol, bupe, and methadone as detox drugs, I'd hazard tramadol is to minor habits as buprenorphine is to moderate habits as methadone is to major habits, i.e.:

TRAMADOL : MINOR HABIT : : BUPRENORPHINE : MODERATE HABIT : : METHADONE : MAJOR HABIT

[doctor diesel]

I've gotta say that trams have always saved me when I've not been able to procure my DOC, which is H. 4x50mg takes all the WDs away, and works for many long hours, the only symptom left to me being a little bit of lethargy.
Tramadol is mighty, mighty impressive as an anti-Jonesing agent.

Doc

[dharma bum]

I have always thought that tramadol was underated as a maintenance for w/d. At one period I got by on them for about 6 months, with the occasional methadone weekend (never more than 40mgs). I took around ten a day. I took four in the morning, then 3 at noonish, then 3 in the evening. And it kept me out of w/d's and raised my energy level to where I was motivated to work and helped with the depression.

But w/d's are subjective...

[Ickyuck]

What Dr.D and DharmaB said... Tramadol has saved my ass during tough WD's. Plus the extra 'kick' of energy is nice.

[bodytec]

i am kicking bupe right now and hydros are working good for me right now,
although i have tried this before and was back at the doc for more bupe,
only to see himm shake his head at me when i told him what i'd done.
he didn't seem to think it would work,but it is doing good right now,
and this is my third try.
yes,my doc also told me to come up with my own taper.
i don't think they want patients to come off.
i have access now to trams so i may try them after a few days of hydro.
i hope the energy thing is true about them,cause lack of motivation/energy is the worst partabout coming off bupe for me. that and the depression.

[lib.sOCialist]

i can attest to 300mg's+ of tramadol, and 900mg's of st. johns wart keeping me a lil better then just not sick. slight mood lift. nothing to write home about.

but i take the SJW because tramadols metabolite of some CYP (dont remember) has high binding affinity to mu receptors.

[Chipper]

I posted his before about Tramadol vs Methadone in detox (I know it's not Bupe but still may be of interest)

http://journals.mui.ac.ir/jrms/article/viewFile/320/121

Trams would work best at the end of a taper or for chippers who get "bitten" occasionally.

[Paregoric Kid]

I take tramadol over buprenorphine EVERY time. I can't stand the thought of going through bullshit precipitated withdrawals and then worrying about it blocking other shit should something good come my way. with tramadol I don't have to worry about either of those problems, in fact should I find something better to take the tramadol acts as a potentiator. I've taken a decent amount of suboxone in my life but after my last couple experiences with it I have tried to swear it off and never use it again, but never say never.
its a real shame tramadol isn't OTC in the US or at least offered as an easy to get detox/maintenance medicine for opioid addiction/dependence.

[hydro chris]

i am kicking bupe right now and hydros are working good for me right now,
although i have tried this before and was back at the doc for more bupe,
only to see himm shake his head at me when i told him what i'd done.
he didn't seem to think it would work,but it is doing good right now,
and this is my third try.
yes,my doc also told me to come up with my own taper.
i don't think they want patients to come off.
i have access now to trams so i may try them after a few days of hydro.
i hope the energy thing is true about them,cause lack of motivation/energy is the worst partabout coming off bupe for me. that and the depression.

sounds like a plan to me.
hope swim will be able to get by wit the trammies.
just a side note or whatever,
swim has had really great results a far as the use of
davercet/darvon years back when detoxing from a decent doses of oxys a few times and..
swims doctor even helped him through w/d's from methadone wit the use of davercet.
good luck man.

[Synack]

When w/ding from 150mg intranasal oxymorphone a day - 300mg tramadol, twice a day, every 6 - 8 hours keeps me well enough to function.. still have some minor symptoms but it's a fucking life saver...

[Narkotikon]

I like the point that PK made, about not having to worry about precipitated w/d or blocking effect with tramadol as you do with bupe. But, if I were given a choice between the two, I'd still pick the Subs over Trammies.

I think Trams would be good for people with lower-end tolerances, or for people who are just starting out and are new to opiate addiction. I think something like that would be a good choice for them. But, for someone who's been on the merry-go-round for several years, and / or has a very high tolerance, I'd stick with methadone or bupe.

Personally, I was never a fan of Trams. They were very easy to get at Urgent Treatment Centers in Lexington, because the people there were under the delusion that they weren't addictive. So, while it was very hard to get a script for even T-3's there, they'd hand out scripts for Tramadol like candy. I think though that Kentucky recently scheduled Tramadol. When I was living there, though, it was still an unscheduled med.

To me, Trams gave me a uplifted feeling, but it wasn't like the energy I got from pod tea. It was more like a cross between that and a coke / amphetamine high. Actually, probably closer to a cross between the pod tea and amphetamine high. It was okay, but not something I thought was euphoric. It certainly wasn't my first choice drug, let's put it that way.

But, yeah, there are lots of things they COULD use for addiction, but don't or won't. They could use benzos more frequently in detoxes. They could use different opiates for maintenance than they use now. They could have different kinds of maintenance, like a low-level maintenance for people who are addicted, but not for a year. I think the rules for bupe / methadone maintenance say you have to have been an addict for like a year minimum. Well, say a person is addicted, but wants help only six months in. Unless they lie, they're not eligible for methadone or Subs. Trams would be a good option for this.