subutex and suboxone question, only reply if you are 100% sure you know what you are talking about DRS PREFERRED!!!

I am SOOOO TIRED of stupid people giving bad advice about subutex because they mistake it for suboxone!! GRR!! I am in w.d and I need sound accurate information about subUTEX! My doctor gave me suboxone, told me to take it as close to the 2 day mark as i could. I did, 42 hours, and I went into precipitated withdrawls. mind you, i am coming off of 30mg methadone which stays in your system significantly longer than any other opiate. I went back and told him what happened, and he gave me subUTEX and told me to wait 36 hours. I am terrified i will take it and go into precipitated again... His advice was bad the first time, why would it be good this time?? Also people always say "if u go into precipitated your opiate receptors are so full from the bupe it can not absorb any other opiates" which is bs because i took 50mg methadone and was ok again only an hour later after the precip. I am clean out of methadone now and I have responsibilities i need to take care of and can not afford to be sick now let alone even sicker later. After my last DAILY dose of methadone, 30 mg, when can I take my first dose of subUTEX? is it any different than suboxone if it is not abused?? thank you for your help!
PS. i am now at a 18  on the COWS scale at 31 hours out

[bellafiore]

now increased to a 24

[laurel453]

Hi... there are no doctors here who can help you but just sent a note to a member who knows about your questions, hope he is around and comes soon.

[vicki595]

Maybe you need to understand the difference between the two meds,as well. Then you would have your answer...I hope you get this figured out very soon...I'm sure you're not feeling very comfortable!

[vicki595]

72 hours before taking any what? Suboxone? Subutex? Methadone?

[HenryS354]

Hi there,

I received the message from Laurel to head over here!  I can certainly understand your frustration as even a lot of physicians dont really understand Treatment using Buprenorphine (Suboxone and Subutex)  Ive had to spend the last 3 years researching this medicine to be able to understand it... docs only have to take an 8 hour online course to prescribe.

Im working flights this afternoon, but just wanted to post now to let you know I'll be back.  I have all kinds of info I can give you, and will be back later this evening after I get off work.

Keep hangin in there, You WILL be ok! :-)

And Laurel and Vicki, thanks for being my scouts for sub posts!!! Its always appreciated!  :-)

Henry

[quadracersteve]

Been there, done that.
Subutex is sometimes given to patients who have methadone still in them, then after a couple days get switched over to Suboxone because of the possibility of abusing Subutex. Coming off 30mg's is usually the max dose a dr. will allow someone to get onto Sub(either one). Possibly, the Naloxone in Suboxone interfered with the methadone still in you causing precip. w/d's.
42 hrs isn't even 2 days, and all dr's I know want you off methadone for 3 days OR when you are in kinda bad methadone w/drawals. That being said, on my 2nd day off methadone, (was on 32mg's) , I took a couple Vicodins because of the w/drawals. On the evening of day 3, I was tested for the amount of methadone still in my system. I only had a tiny bit, (also popped positive for opiates, but explained why), and was given my dose and felt fine in 1/2 hr. Actually, felt great. According to my dr, 30mg's of methadone is equal to 24mg's of Suboxone.
Did your dr test for the level of methadone still in your system? Should only take 20 minutes to test. That's one of the reasons your initial visit costs so much. For the test.
We all metabolize it differently. Maybe you're on the slower side, but still, 42 hrs doesn't sound like enough time off methadone to make the jump. And don't worry about what you scored on the COWS scale. That # is a bunch of crap. It all depends on the amount of "done" in you, and you can only find that out by being tested.
Either your dr is an idiot and didn't test your methadone level or gave you the med too soon. The only thing that really matters is you need to be in w/drawal before taking Suboxone.
When it comes time to detox off Subs, learn the "liquid taper" method if you don't know it already. It will make your detox SO MUCH easier. Good luck. Hope this helps.

[Dknd4v]

exactly. Weather its subutex or suboxone you have to be in withdrawl (withdrawal) before you initially start it.

[HenryS354]

How are you holding up?

Sorry about the late response, it seems every flight I have worked this week has been delayed!  At any rate, lets see if I can help you out here.

Buprenorphine is such a unique and often misunderstood drug. The reason being it has multiple methods of action, and some contradict the others.  

Buprenorphine works as both a Mu Receptor Agonist (Activating the receptor causing euphoria) as well as an antagonist (Binding to the receptor displacing active metabolites causing withdrawal and blockade)  Both of these properties are directly dose dependant.

In low doses, Buprenorphine acts as an agonist and quite a strong one at that.  At doses in the range of 0.3-0.4mgs, Buprenorphine has an analgesic potency roughly 30 times that of morphine.  When bupe is used for pain management (Which has been a standard of care in Europe for some time now) typical dosages are in this range, this range produces profound pain relief, and Euphoria.

As the dosages increase, Buprenorphine begins to switch over to its antagonist property and exhibits the blockade effect.  In maintenance treatment, Bupe still partially occupies the Mu receptor, however not enough to actually activate.  This tricks the receptor into believing the original opiate is still there, however it does not produce the euphoria inducing impulses that full agonists produce.  This is why Buprenorphine maintenance doses are significantly higher, in the 4-16mg range.  

Most people believe that precipitated withdrawals are coming from the naloxone in the Suboxone combo.  While there is some truth to this, a general answer would be "no"  Naloxone (The FULL Antagonist in the Suboxone combo) Has an extremely poor sublingual bioavailability... meaning very little of the drug is absorbed via the sublingual route.  There are cases where this minute amount can cause minor precipitated withdrawal syndrome, the general consensus is that it does not.  

The concept behind the Buprenorphine/Naloxone Combo is that when taken as directed, the Naloxone is Inert, and exhibits no effect on the patient due to its poor sublingual/oral bioavailability.  Its incorporated as a back up to deter abuse of the tablet by parenteral use.  Naloxone has a very high Intravenous Bioavailability, thus if the user injected the drug it would 1) Cause and Extreme Precipitated WD syndrome, and 2) Render the Buprenorphine useless.

Not only does this make the drug safer for IV addicts, but all addicts as well as it reduces the chances of diversion to non prescribed users of the drug.  

The Subutex formula was created for Patients with a known or suspected hypersensitivity to Naloxone (In some patients, Naloxone can cause excrutiating headaches), And women who are pregnant.  In some clinics, Subutex is used as the Induction drug, and then switched to Suboxone for maintenance purposes.  Utilizing monotherapy with Subutex, the physician can better pinpoint any reactions during induction.  The less substances involved, the easier it is to pinpoint a problem and properly titrate a therapeutic dose.

As far as your precipitated withdrawals, I wouldnt discredit your doc just yet.  Buprenorphine induction is a tricky science.  Legally, I cant suggest when its "safe" for you to redose with the subutex.  What I can say is that I personally would go as long as I could, and then a few more hours after that.  When I inducted onto Sub, My last dose of Methadone was 20mgs, and I went 72 hours before induction.  I was inducted onto Suboxone at 4mg's with no problems at all.

Clinically, if you are scoring 18 on the COWS, you should be ok to dose.  However as you can see, there is no textbook "Standard"  Personally I would try to wait until you are at a score of 24, The highest end of the "Moderate" range before dosing again.  

To answer your last question, When taken as directed, and there is no known hypersensitivity or contra indication to naloxone... Both subutex and suboxone are clinically equivalent.

A good source of information is the Substance Abuse and Mental Health Services Administration TIP 40 "Clinical Guidelines for the use of Buprenorphine in the treatment of Opioid Addiction"  Which you can find here:  

http://buprenorphine.samhsa.gov/Bup_Guidelines.pdf

Its a long read, but is full of clinical literature and guidelines on buprenorphine treatment.  Its not a very technical read, so will be easy to get through with limited previous medical education.  

Page 32 of the PDF "Buprenorphine: A New treatment for opioid addiction" starts some good information on how Buprenorphine works, and affects different patients differently.

And another good section for you to read starts on page 78 of the PDF "Patients Dependant on long acting opioids" Outlines the reccomended induction guidelines for patines on maintenance methadone or LAAM therapy.

I hope I didnt confuse or frustrate you even more so with this info.  While I know it can be frustrating, and controversial, When buprenorphine is used as a co-comittant treatment with counseling and behavioral therapy, and the patient acts as their own advocate and educates themselves the best they can... Buprenorphine treatment can be a real lifesaver.

I started treatment on Suboxone 4 years ago after battling a 10 year addiction.  In May of 2010 I detoxed off Sub, and have been living a clean and sober life for the past 479 beautiful days. It truly saved my life.

Keep posting and let us know how you are doing.  Please feel free to message me or post anytime if you have any other questions.  Until then, You're in my thoughts.

HenryS354