An Important Caveat for Anyone Considering Buprenorphine Maintenance

[limitless_euphoria]

Great thread, I'm glad it got stickied-I just read the whole thing and I've never taken a bupe in my life. I was on done for a year (last 6 months were tapering with no problem-perhaps because I went right back on dope) and tbh never considered bupe-I'm not sure why but reading this stuff makes me glad I gave it a miss.

First off, I'm honored. My first sticky ever! But really, I've got to say, it's more than just having a claim to fame.

CZ: I'm glad that at least you were afforded the knowledge shared in here. There aren't too many other places on the net that tell the whole story about buprenorphine: good, bad and ugly. Places like suboxonetalkzone . com are useful but sites like that are obviously dedicated to recovery vs. all things bupe (including how to IM, take advantage of low dosages and even catch a buzz off of it). Opiophile's buprenorphine sub forum rivals that of any other site I have seen.

Hey, if this thread only causes a handful of readers to rethink long-term maintenance and weigh the pros and cons more carefully before induction, I feel it has served its purpose and I've done something worthwhile for my fellow opiophiles.

This thread has definitely sparked some very deep conversation (both nerdy and anecdotal) which is exactly what my intentions were in the first place.

Lastly, a big thank-you to whomever made this a sticky. That way it doesn't get buried dozens of threads back.

[Thanat0s]

been fuckering with subs for 4 years now and im terrified of being a long termer...

[dougrounds]

thant0s, do you have any experience with the suboxone films? i dont seem to get the same relief i get from 1/4 of a suboxone/subutex pill (roughly 2mg buprenorphine) with 1/4 of one of the newer films.

i had to follow you here from the old site, as i always found your bupe info to be the most helpful. thanks in advance...

doug

[Thanat0s]

glad to see ya here doug!

ive yet to come across the strips but know a few people who have.
had mostly positive reports,
the only thing i can think of in your case is if taking it sublingualy
the strips dissolve MUCH faster.
depending on your technique it may not be absorbing quite right.
excessive saliva could be the culprit.
gotta change yer tech with the strips.

might help if ya can give a description of what your subL dosing is like:
ie: how long to totally dissolve,
how much saliva do you produce when dosing,
what do you do with the saliva,
condition of mouth before dosing,
do you spit or swallow when dosing..
?

id try drying out under your tounge a bit by exposing to air before putting the film under.
you can also 'prep' your mouth with a thorough brushing and rinse with alcohol based mouthwash.
try to keep saliva on top of your tounge and away from the strip for a good ten minutes.

huge problem i have with the subL ROA as absorbtion can vary so wildy depending on many factors.
if all else fails you might have to simply up the dose you use,
simply because you are not getting the same % of the med as you were with the tablets.

i do think some people's technique is simply better suited to the slow dissolving tablets,
you may be one of those people.

i know the tabs are still widely available,
maybe talk to your doctor or pharmacist about switching BACK to the pills.

you can always mix with a small(30units) amount of water and snort or plug it.

hope that helps,
and thanks much for the report,
id considered that such a problem could arise for some,
good to have it noted here.

feel free to VM me or update here with any mroe question or if you find a solution.

[danny]

very informative thread this, unfortunately it makes me wish i had a handgun somewhere close, cause the general consensus of people on here FAR FAR cleverer and more educated than me are telling me this is pretty much it as far as quitting is concerned after 16 years at it, i wish that i could accept opiate addiction with the grace of some of my peers on here but im too much of a coward to say fuck the world, this is me, take it or leave it - cause i havent done that and already, most people have took the second option...not only that i cant accept methadone as a substance that i wish to spend my remaining years addicted to, i think the school of thought that say its harmless are confused, it might not kill ya, but it sure as hell fucks you up in a whole heap of different ways.....

[Indy]

Quitting is cowardly....wow are we all that backwards? lol. most people would say not quitting is cowardly, escapism, blah blah blah. the fact of the matter is you can make anything sound like the cowardly decision and anything sound like the brave one. cowardly and brave don't really mean anything anyways, so i wouldn't judge yourself based on that.

"you don´t have to step forward to be a hero -- everyone else just has to step back."

[danny]

i dont know, i think people who accept the fact that theyre going to be opiate dependent for the rest of their lives, and refuse to let other people see them through their prejudices, even to the point of not having anything to do with those people, and the people who accept certain intrinsic limitations of living a life that they enjoy but dont allow anyone else to limit them, yeah, that is brave to me....having said that its also brave to struggle against your own self and win when youve been caught in addiction for x amount of years, very few people manage that either - unfortunately i seem to be trapped somewhere in the middle...

i still cant see where you got 'quitting is cowardly' from my above statement though....or how what i said makes me backwards....

[Thanat0s]

i must agree with ya danny.

[OrangeLude]

very informative thread this, unfortunately it makes me wish i had a handgun somewhere close, cause the general consensus of people on here FAR FAR cleverer and more educated than me are telling me this is pretty much it as far as quitting is concerned after 16 years at it, i wish that i could accept opiate addiction with the grace of some of my peers on here but im too much of a coward to say fuck the world, this is me, take it or leave it - cause i havent done that and already, most people have took the second option...not only that i cant accept methadone as a substance that i wish to spend my remaining years addicted to, i think the school of thought that say its harmless are confused, it might not kill ya, but it sure as hell fucks you up in a whole heap of different ways.....

Well said Danny. IMHO mmt is not harmless & far from it. There is a severe price that comes along with the stability of mmt. If it is not used as a bridge it is more harmful the longer the term. No doubt though the experience is different for different people. For some long term mmt is a life saving experience. Not mine.

[limitless_euphoria]

i dont know, i think people who accept the fact that theyre going to be opiate dependent for the rest of their lives, and refuse to let other people see them through their prejudices, even to the point of not having anything to do with those people, and the people who accept certain intrinsic limitations of living a life that they enjoy but dont allow anyone else to limit them, yeah, that is brave to me....having said that its also brave to struggle against your own self and win when youve been caught in addiction for x amount of years, very few people manage that either - unfortunately i seem to be trapped somewhere in the middle...

Seems like there's always going to be the anti-maintenance crowd out there but I've always looked at it like I don't owe anything to anyone but myself as far as whether I quit bupe maintenance or not. It's what works and sure, if I could have my physiology rebooted I'd consider going without but now I've gotten to the point where I have back and knee pain that's not chronic but persistent enough, especially in bad whether or when I have to shovel a metric fuck-ton of snow, where I need something. Nobody is going to give me the good shit nor should they. Bupe is 25-40x the potency of morphine and when not taken at the high doses sub doctors seem to recommend it's not a half-bad analgesic. I'll take what I've got, not worry who thinks what about me, and call it a day!

[danny]

one of the things i find so hard to accept about lifetime maintenance is that you are essentially putting yourself into the hands of the state, its already been established that your demographic is despised by that same state, and if ever a handy folk devil is needed to divert the attention of the sheeple from the things that are really going down the toilet youre favourite to be in that position...and then youre relying on their, not even good will, but the fact that they can make less political capital out of throwing you in jail/withdrawing all medication instantaneously/withdrawing all access to social security or healthcare cause YOU DID IT TO YOURSELF than they can by not doing those things

now at the moment those things may seem far fetched, but i dont for one minute believe the economy is gonna get better or the world any securer in the foreseeable future, quite the converse if anything, when shit really starts to hit the fan who do you think is gonna be first in the firing line? call me a paranoid but id hate to be 60 with no income and a 250ml a day methadone habit when all of a sudden the government decides it cant provide your medicine any more

id go for it like a shot if i thought we were gonna see a return to the days of 'the british system', when it was accepted that some people were in fact going to become opiate addicts, and the only way to treat them humanely was with substitution therapy, hopefully maximising the amount that these people could contribute to society and vice versa, and if at some point in the future they wished to stop, then there was still a person left to treat - unfortunately the 'war on drugs' has ensured that the fundamental treatment for addicts is punishment and marginalisation - im not a huge flag waver for the capitalist system in general, but thats the paradigm that were supposed to live under, and even i can see that just the economic reasons are overwhelmingly showing that the war on drugs is an absolute perversion and failure, for some reason its become the elephant in the room that even sensible or well meaning politicians cant discuss (if there are indeed any left) without the howling of our self appointed moral guardians in the media

[dougrounds]

thanks a alot, thant0s.

typically, i try not to eat or drink anything within 30min before and after dosing.. swim puts the 1/4 piece of a strip under there... and tries to just forget about it. i dont spit out any saliva.

swim took maybe 1/6 of a strip today, and took a tiny, tiny, tiny little bump of some crushed subutex. we are talking like 1/40th of a 8mg pill, here. and i actually felt okay.

tommorrow swim will most likely sub-l 1/6 - 1/4 of a strip, and report back.

about a week ago or so, swim got some methadone, so swim took 24hrs off from the bupe, and did the methadone program for maybe 2 days or so. actually felt really nice. anyways. glad to see i can still keep in contact with everyone from the old phile... take care, guys

[kevin]

L_E,

Your story in many ways mirrors SWIM's story. He has been on bupe for about 4 years after about a 10-year opiate addiction. That said, he has left illegal and all prescription drugs (aside from prescribed Effexor and, of course, Suboxone) behind completely. SWIM takes an 8mg strip in the morning and one in the evening and otherwise goes about his day. SWIM went from living across the street from a crack house in a small shack (essentially) with FOUR CATS - it was probably when SWIM was at his worst physically as well, shooting at least 150mg of morphine a day plus whatever else he could get his hands on (usually coke and/or oxy) - to living in a nice, upwardly-mobile middle-class neighborhood in a really beautiful home. SWIM went from being unemployed and out of school to getting his B.A. in History and International Affairs and is currently working on his M.A. in Latin American History and employed doing research at a major University. SWIM's arms have healed (well, there are some veins that never truly return) and so have his relationships with his family and his friends. SWIM lives the dream life. The only thing that could make it better would be to go to the doctor once every 4 months instead of every 2. SWIM realizes that being on a drug for his entire life isn't ideal, but bupe has truly allowed him to create a new life. SWIM has tried to taper off of bupe twice but failed. If SWIM has to go to the doctor 6 times a year and piss in a cup occasionally and take a strip twice a day - if this is all SWIM has to do, in the grand scheme of things, SWIM is quite content with that

SWIM's doc also made it sound like coming off of bupe was nothing compared to morphine or oxy or methadone. But SWIM has been on all three and detoxed from methadone and morphine using a slow taper. SWIM believes that while coming off of bupe is not as bad as methadone (even tapering down to 5mg before tapering off) or morphine (tapering off at 1mg). Bupe withdraw does not give you the horrid flu symptoms that morphine does or last 2-4 weeks like methadone. That being said, it's the psychological factor that always seems to doom SWIM - the crushing anxiety/panic/fear/agoraphobia - a perpetual sense of impending doom.

SWIM's warning to those considering bupe treatment:

Prospective bupe patients should know that if they have had a light opiate habit for a short period of time (say less than 2-5 years [or longer] always depending on the individual) then perhaps there are alternatives. SWIM recommends a short-term detox facility in your area (those provided by the state aren't great, but they are bearable) and then consulting a physician about whether or not bupe is right for you.

Obviously, if you have had a habit (heavy or not) for more than about a decade, odds are maintenance is going to be the only thing that lets you live a normal life.

Make sure you steer clear of docs that only take cash or won't take insurance, that shit would fly when SWIM first started suboxone maintenance but now there are too many legit pain management docs or substance abuse doctors prescribing bupe.

Know the choice of doctors in your area, shop around until you feel you find a doctor/staff that you can work with.

In Florida, this is what SWIM pays (SWIM has state insurance) for suboxone therapy (the whole deal): appointment (copay $40), suboxone (usually free - they keep sending SWIM's doctor massive amounts of free coupons (they are encouraging folks to switch to the strips).

SWIM lives in a mid-sized city - most places now have multiple doctors if you search online.

Oh, SWIM wanted to mention one last thing: buprenorphine side effects can be a bit crazy when you first start taking it. The more of a drug you take, the more pronounced the side effects become. When SWIM first started taking bupe, a doc put him on 24mg/day which made him incredibly manic and sick in multiple ways. Most doctors don't advertise that some folks have quite strange side effects when taking higher doses (24/32mg).

Good luck.

[doctor diesel]

I fucked with opies for nine years then went on bupe maintenance for two years, reducing my dose over the last six months of that two years.
I eventually jumped off at half a milligram, took one dose of codeine daily for a fortnight, then that was it. I had no physical withdrawal symptoms and no mental distress - no depression of any kind.
Maybe I'm unique, possibly I'm typical, I don't know. But a two-year run caused me ZERO problems.


Doc

[reddragon3668]

I can't speak to the bupe issue, but I can speak to the 10+ years of serious opiate abuse and getting clean. Eventually, you can and do feel normal. It just takes a while.

[jimmyfingers]

I fucked with opies for nine years then went on bupe maintenance for two years, reducing my dose over the last six months of that two years.
I eventually jumped off at half a milligram, took one dose of codeine daily for a fortnight, then that was it. I had no physical withdrawal symptoms and no mental distress - no depression of any kind.
Maybe I'm unique, possibly I'm typical, I don't know. But a two-year run caused me ZERO problems.


Doc

I painless taper is obtainable. Like Doc, I had almost 0 w/d symptoms. I even slept every night.

[syntheticlove]

Suboxone and Methadone are two things that I will never do again longterm (more than 1-2 weeks).

I also will not take methadone at all unless for some reason I need opiates and it is all that there is left on the planet. The stuff is really bad for my TOLERANCE when used occasionally.

My experience involves a 3 year methadone habit (160mgs), after a 7 year hydo, oxy, fentanyl, morphine, and Heroin habit. During my decrease, I could not get below 70mg due to health problems. Therefore, I did a hellish switch to suboxone(7 months on it) after a 1 week methadone decrease to 37mg.

After losing my doctor due to moving and no money, I came off of suboxone over a month of weening down. The kick after jumping at 2mg was CRAZY anxiety and the rare vomiting. I have been chipping black tar heroin for the last 2 months and am ready to quit anytime now.

Suboxone for kicking is a LIFESAVER. Just don't take it too early and not longer than 5 days.

[tupperwareparty]

I'm in my twenties and have been on bupe for a year come January. The duration of my "career" in opiates (exclusively bth) prior to my first induction wasn't very long (maybe a year all together..) but I'm still glad I started Subs. I have found buprenorphine to be incredibly and amazingly awesome.

I had always felt that sensation of loneliness and mild sadness that I think a lot of us have experienced. I suppose it might be considered some kind of depression but I like to think that even when I felt crummy, it could always have been worse and that I have a lot to be thankful for. I never really had much of a "bottoming out" as can often be the case when one decides to enter a program of recovery. I hadn't even been getting sick for that long,, maaybe a few months..

I was started off at 12mg / day and then increased to 16, then again to 24. I stayed at 24mg / day for quite some time before deciding to move down a bit after having read about all youz guys' opinions and whatnot. I jumped down to 4mg / day then to 2 in a matter of two or three weeks all without (dare I say) *any* ill effect. Obviously I was on too high of a dose and was probably just peeing out a lot of it anyway.

I now take anywhere from 2 - 8 mg / day (no more) and am feeling quite fine (I tend to hang out on the lower half of 8mg). I think I'll be on Suboxone long-term and am totally cool with it; especially if my long-term dose is 2mg or lower / day.

I loove the smell and taste - I associate them with feeling better!! How is that not appealing?? I don't understand how people don't like it..

I am stoked on Suboxone strips because they are just the shit, plain and simple. They make dose regulation soo much more efficient than with the tablets (aka "stop signs" lol). What do people think about which one dissolves/is absorbed "best"?

I currently have pretty good insurance and am getting my monthly rx for a steal with the Suboxone coupon (again, a lot to be thankful for).

If I didn't have to worry about things like $ or insurance or etc then yes, I would probably stay with LT bupe regimen

[limitless_euphoria]

Hey TWP, how are you? Happy 2013.

It's ironic you posted in this thread (my one sticky), I was JUST about to start a thread regarding generic buprenorphine (generic subutex) vs. the strips.

I've never actually had a 'real' strip, unless you count the placebo my ex sub doc gave each of his patients. I felt like saying to him, "why am I trying this if there's no medication in there again---I've had dissolving breath-freshening strips before!"

Anyhow, check for a new thread to appear in a few minutes. I need to get advice on behalf of my good pal SWIM.

[tupperwareparty]

Hey LE just noticed this post.. The year has found me well thus far and I'm enjoying it.. As you may see from my post count, I'm relatively new and am not sure where I might find said new thread. But I'll reply here and then maybe as a visitor message on your profile (if thats an appropriate / efficient way to get ahold of new thread location ?)..

I've tried Subutex, Suboxone tablets and Suboxone strips and could maybe contribute? Let me know!

[Duckfeet]

Who knows why...I"ve got off dope for five years and six years at different times...after first few months, I didn't miss it...but after a few years, I forget the hell that comes in it's wake, and figure I can do shot...usually I'll just stumble on a doc who offers them, or a heroin connection, or last time, I just got knocked out and ended up in a hospital, and when I came to, they were giving me dilaudid shots...since then, about 7 years fighting...and I couldn't quit bupe, tho I tried hard a couple times...so I'm back on methadone, tho honestly, I always fight that too...most people get off dope eventually, it just gets too hard to hustle, or you get busted off the streets.

We just aren't good at quitting, that's all: if we were, we'd be able to quit our DOC...the only reason I get on methadone--or bupe--is because I can't take withdrawal symptoms. But I've known too many long term junkies who have gotten off it for good: I don't really believe in the permanent damage: if it changes one way, it can change the other...I believe tho, that once you know that euphoria that opiates give you, you never forget. But you do forget the pain that kicking causes, or you think that *this* time, you won't get all strung out, that *this* time, you'll only eat oxys just once, or just get this *one* shot of heroin, blah blah blah...we are nothing if not delusional.

[holladimsum]

Who knows why...I"ve got off dope for five years and six years at different times...after first few months, I didn't miss it...but after a few years, I forget the hell that comes in it's wake, and figure I can do shot...usually I'll just stumble on a doc who offers them, or a heroin connection, or last time, I just got knocked out and ended up in a hospital, and when I came to, they were giving me dilaudid shots...since then, about 7 years fighting...and I couldn't quit bupe, tho I tried hard a couple times...so I'm back on methadone, tho honestly, I always fight that too...most people get off dope eventually, it just gets too hard to hustle, or you get busted off the streets.

We just aren't good at quitting, that's all: if we were, we'd be able to quit our DOC...the only reason I get on methadone--or bupe--is because I can't take withdrawal symptoms. But I've known too many long term junkies who have gotten off it for good: I don't really believe in the permanent damage: if it changes one way, it can change the other...I believe tho, that once you know that euphoria that opiates give you, you never forget. But you do forget the pain that kicking causes, or you think that *this* time, you won't get all strung out, that *this* time, you'll only eat oxys just once, or just get this *one* shot of heroin, blah blah blah...we are nothing if not delusional.

i think that the word delusional explains the root of the problem for me when it comes to STAYING off the stuff. i have gotten the stuff out of my system many, many times. to me this cancels out the idea that it is some sort of physiological craving that gets me going again.

the moment before i put the needle back in my arm, after 1 month/6 months/2 years off the stuff, it is entirely a mental problem. it isn't as though i have a weak will, but the mind that is the planning room upon which the will acts is definitely compromised when you take into consideration that i have been at the "i will never do this again ever ever ever" point ad nauseam. one would think after getting the sutf out of my system that i would use this info to make a better decision in the future. i can't tell you how many times i have said that i would rather die than go through the stages of another run. i look at all this and find it absolutely amazing, almost laughable how my mind operates, and will continue to operate even though i understand (and have for almost 10 years) the process from beginning to end.

[limitless_euphoria]

Wow. I just referenced this thread and it shows up fresh again. I'm back at it after stopping two weeks. I forgot how nice those 2 mg generic bupe pills are. They were mine for the asking (just said so because it's a cheaper copay mainly).

What's great is that I found a doc who cares but who also believes in the free market. It's on you to be honest. Unlike my last doc, AA meetings are fine. There's no mandatory med group with the same basket cases every week; you pick a couple meetings a week you like but he suggests NOT going to NA. There are plenty of cross-addicted people at AA anyway. Those of us who have been know this.

The thing that's key is that I've sworn off booze and tobacco. I just want nothing to do with either of them. Now if I can land a good job, I'll really be in good shape!!!

I tried detoxing for those who followed that saga, yeah, I went back but you know what, having the right doctor and perspective helps. I just hate to see anyone get involved without the REAL info and anecdotal advice UP FRONT.