subutex

I need some help with the proper way to take Subutex and Suboxone.  I have 15 white oval shape 8mg Subutex and 5 orange color six sided tablet Suboxone.  I want to get off a 3 month Heroin run and don't know how to take the Subutex or Suboxone.  I haven't done anything today since 1:30am pacific time (Los Angeles, Southern California).  I really want to get clean because I had 17 years in recovery (NA/AA/CA etc.) and relapsed behind a work related injury and pain meds (Norco).  
Can anyone give me some direction here with the Subutex and Suboxone?  What's a good sleeping med that doesn't give a bad hangover?  I'm asking for help in that area also.

Thank God for One Addict Helping Another
StraightUp

[GoingToMakeIt]

I am not able to help you. Hang tight and I am sure someone will chime in who is experienced with this.

[OBXman]

Unfortunately, I'm an old pro, so here goes:

Taken sublingually, Subutex and Suboxone are exactly the same. Both contain 8 mg. of the active drug buprenorphine. Suboxone has 2 mg. of naloxone added. Naloxone is an opiate antagonist, but is only active when used IV. It has no effect whatsoever when taken orally. Naloxone is added to Suboxone to discourage IV abuse of the bupenorphine. Subutex is rarely prescribed, reserved only for those with an allergy or hypersensitivity to naloxone. Taken as directed, sublingually, the two brands are interchangeable.

I'm assuming you got these drugs "on the street" and not from a doctor, since you don't know how to use them. Better to find a good doctor with the special DEA license to prescribe them. That way you get good medical guidance during your detox. But that wasn't your question.

Before taking your first dose you must wait until you begin experiencing physical withdrawal. That doesn't mean you just feel bad mentally, wait until you are actually sick (i.e. aches, tearing, sneezing, diarrhea, etc.). It is very important that you wait, or the bupenorphine won't work properly. You don't need to remain suffering in this state long, but you must be in the beginning stages.

The way these drugs are taken is sublingually, meaning under the tongue. Do not swallow the tablet whole, it won't work if you do. Begin with one-half tablet. Place it under your tongue and keep it there until it is completely dissolved. Do not eat, drink, smoke or talk while the tablet is dissolving. For most people this takes 10-15 minutes. For some reason it took half an hour for me. Look in a mirror to check that it's completely gone.

How much of the drug you require depends on how high a dosage you are addicted to, of the other opiate. One half should make you feel a little better within 15 minutes after it has dissolved under your tongue. Take the other half if you still feel ill. Continue one half at a time, waiting at least 20 minutes between each dose. Most people need 1-1/2 to 2 tablets (12-16 mgs.) to feel okay. You might be fine with one tablet, or you might need as much as two (16 mg.). If two tablets don't take all of the sickness away, you really do need to see a doctor.

You'll never get the high you experienced with what you were taking before, so stop when the sickness goes away. No more than that! Then you will know the dosage you require. If you take any more than "just enough" you might experience side effects such as nervousness and insomnia. The medical term for this is "titrating up." You may take your dosage once a day, in the morning. If the effects don't last a full 24 hours you may divide it into two doses if you have to. But since the drug can cause insomnia, it's best to take it first thing in the morning.

Since you only have 20 tablets, you'll have to soon begin titrating down. Do this in 2 mg. (or one quarter tablet) increments, until you are comfortably down to one quarter tablet a day. Coming off of 2 mg. is no day at the beach, but it's a far cry from what you'd experience cold turkey without the Suboxone.

You didn't ask for this advise but I'm going to give it to you anyway: Use the time you have while taking these 20 tablets to find a doctor who can prescribe Suboxone, and get into see him or her as quickly as you can. Twenty tablets is barely enough for detox. In the long run, it won't do you much good to take your 20 pills and go right back using again. Good luck!

My best wishes to you,

Marc

[OBXman]

Oh, I forgot about your question concerning sleep meds. Without a prescription the best you can do is diphenhydramine. Benadryl is the common brand name. It's also the sleep aid ingredient in Tylenol P.M. Buy a generic and save a lot of $. It's sold as sleeping medicine and also allergy medicine; tablets, capsules or liquid. Just look for the fine print on the box "diphenhydramine HCL, 25 mg."  Take two (50 mg.) for sleep. It's not the best sleep aid in the world, but it's OTC, cheap, safe and non-addictive. It works for me!

Marc

[wait2long]

OBXman is correct...except i have found it can take up to 1 1/2 -2 hours after the tablet has dissolved to feel the full benefit of the sub..so i would recommend spacing the doses an hour or more apart or you may end up taking more than needed.
in my profile i have what they suboxone doctors call an opiate withdrawal chart...my doc told me to score around a 15 before i took my first dose of sub...the longer you can stand to be in withdrawals, the better you may feel and quicker.  DO NOT take them sooner or you will be put into precipitated withdrawals and trust me you do not want that!! ITS THE MOST HORRID FEELING and near impossible to stop once it starts.
I also have to stress OBXman is 100% correct...you barely have enough to get you through withdrawals...what are you going to do when the suboxone is gone?  what is your plan?  you really should find your own sub doctor, get into some counseling or therapy or even meetings, whatever you choose, but it has to be something that will help you through the hard part, and the hard part is staying clean...not getting clean.  withdrawals are awful but its only about a week or so (aside from methadone) of misery, where as staying addiction free is the rest of your life...you need a plan of action on what and how you will do this when the sub is gone and your withdrawals are over with, or your effort very well could be wasted...GL to you and if you have anymore questions...let us know.

[GoingToMakeIt]

Good advice and welcome.
Melatonin also helps with sleep. For a short while you can take up to 10mgs. Use whatever works for you.

[wait2long]

also i would like to stress that you should start your induction with the subutex, when that is gone switch to the suboxone...

[wait2long]

Melatonin can help with sleep...in someones (fladdicts i think) profile i read anywhere from 1 mg up to 30 mgs will help, you have to find what works best for you, but start off small. and the room your sleeping in has to be dark, this is when the melatonin works its best...

[StraightUp]

Thank you Mr. OBXman for all the info on Subutex and Suboxone.  I really am going to approach this with care since you shed some light on the meds. Good info and I'm grateful to you for sharing your knowledge with me and the rest who read the forum.  I have an appointment with a doctor this coming Tuesday morning.  He's trained and certified in administering Subutex and Suboxone.  I'm going to do the detox with these meds with his direction and guidence.  Thanks to you and the info you shared.  

I'm glad I ran across this forum and people as yourself.  
Happy New Year and God Bless.
StraightUp

[OBXman]

Nice to hear I could be of some use to someone. Thanks. I'm REALLY happy to hear you're going to Suboxone Doc. You're on the right path now! Let us know what happens, okay? I wish all the best to you, and to all the others here who suffer as we do...

Marc

[wait2long]

i was wondering, what have you heard about why you are not supposed to take benzos (klonipin (klonopin) for example) while on suboxone? i am getting conflicting stories on this, a friend of mine and i are trying to figure this out...our sub doctors have told us each 2 totally different stories...whats yours?

[StillTrying101]

Hi,
Advice above is all great, except with the subutex (the white pills) you do not need to wait until you are in withdrawals to take your first pill.
You can definitly detox with twenty pills even from a pretty heavy herion habit. In my experince, about 4 or 5 days afer my last dose, I would always feel like **** and relapse (prehapse becase of the long half life). Now that I am on a maintaince dose i have been sober for almost 6 months. (I too had 5 years sober without any mantaince programs...so it was hard to finally give up and go on suboxone long-term)
You really shouldn't need any sleeping pills with the subs, they work that good.
As far as subs and benzos...the most common cause of death from suboxone overdose was because of a benzo and sub mixture. So I just wouldn't screw with it!

[StraightUp]

Thank you for the input on the Subutex.  I made a conscious decision to see a doctor begining Tuesday.  I've been doing pretty heavy doses of Heroin a day for about the last 3 months.  I had 17 years of being clean and sober and got on pain meds due to my cervical disc injury. Norcos just sent me back to my old favorite drug "Heroin". I want my life back, and your words are encouraging since you state the Subutex should work for a Heroin habit and shouldn't need sleeping meds.

Thanks again
God Bless
StraightUp

[needhelpnj]

I am about to start up my second roung of suboxen.  Unfortunately, I do not have subutex, I only have suboxen.  You mentioned above that you need to start with the subutex.  Will starting and staying on suboxone only be effective??  I got the suboxone from a doctor after an office visit that used the Subutex.  I wasnt given subutex to take at home.  I would really appreciate your feedback.
needhelpnj

[OBXman]

I'm sorry, but I must respectfully disagree about Subutex somehow being different than Suboxone. No, it is NOT okay to begin Subutex without waiting for for withdrawal to begin.

This is why: Buprenorphine, the active drug in both meds is classified as a agonist/antagonist. Drugs like hydrocodone, oxycodone and heroin are pure agonists. Naloxone is a pure antagonist. Chemically, buprenorphine is somewhat in the middle. It's unique that way. That's why it doesn't make you high, but prevents withdrawal. That's why it blocks pure agonists (if you take a few Percocets or shoot up some heroin after taking either Suboxone or Subutex, you won't feel anything).

Since buprenorphine does have antagonist qualities it will send you into withdrawal if you still have a pure agonist in the opiate receptors in your brain. YOU MUST WAIT UNTIL PHYSICAL WITHDRAWAL BEGINS BEFORE TAKING EITHER SUBOXONE OR SUBUTEX.

Naloxone is added to Suboxone for one purpose only: to discourage IV injection. Period. No other reason. Naloxone has an effect ONLY if it is used IV. The small amount of naloxone in Suboxone has no effect whatsoever when taken sublingually (under the tongue). It also has no effect if swallowed; the stomach acids would kill it and never enter the bloodstream. Perhaps very large oral doses might do something, I don't know. But I do know that the 4:1 ratio of nalozone in Suboxone is much too small to have any effect, when taken orally.

There is NO advantage in beginning treatment with Subutex, as opposed to Suboxone. It makes no difference which one you take and when you take it, they are absolutely interchangable. I don't know why the manufacturer has these two different versions, it obviously creates a lot of confusion.

I don't want to be disagreeable, and I don't want to come here and sound like I'm arguing. Everyone here is very kind and I have received a lot of good information and support. But I felt I must speak out on this one. I believe what I wrote above to be true. I'm sorry, but telling someone he/she doesn't have to wait until withdrawal to begin Subutex, and that it is better to begin with Subutex than Suboxone is just wrong information.

Please accept my contradictions in the spirit in which they were given, but PLEASE heed my warnings also.

Marc

[beenthrualot]

my doc gave me 3 subutex every 12 hrs next 12 hrs move to suboxone I had a massive panic attack and he prescribed adivan a mild benzo so it is ok to mix never overdue anything while trying to get clean but I took the adivan and panic attack went right away but beware now I am in the process of weening off xanax a much stronger benzo because i liked what it did and got addicted to something new. good luck a mild benzo helped me at the time I chose to go for stronger benzos my bad but if you take benzos for first 2 or 3 days you will be fine.

[4181steph]

Ur right. I was snorting heroin for 2 yrs then went on methadone for 7 yrs before I went to a suboxone doc. He prescribed subutex in office. I took 8mg and about 30 min later I thought I was gonna die!!! this was by far THE WORST WITHDRAWAL I've ever experienced! and it comes on hard and fast and i've detoxed cold turkey off of heroin in jail numerous times. I have been on subutex for 4 yrs now. I lost my health insurance and today went to a new doc who would not prescribe subutex, just suboxone. I'm wondering why since I've been stable so long on subutex and have never injected? He also told me to wait to take the suboxone (b/c of the naloxone) until I was in moderate withdrawals from the subutex. I cant find ANYTHING on the internet to support his claim. I was told by my old doc that the proper way is to use subutex for the induction then switch to suboxone. He also told me that the naloxone keeps iv abusers from getting high and that's why they put it in there. but he kept me on subutex the whole time....now 4 yrs later my new doc prescribes suboxone! I;m confused and I already have severe anxiety/panic attacks for which I take clonazepam. both subs are partial agonist, so why do I have to wait until WD's like I did when I was on methadone which is a full agonist?? My old doc said they start u w/subutex because the naloxone in suboxone may increase ur chances of precipitated WD's, but also said that if taken sublingually, the naloxone has zero effect. whats the truth?! I've had 3 different doc's tell me 3 different things! I took my last subutex today. Supposed to start suboxone when I;m in WD's.