Suboxone induction, please help me!

[werdna]

I have heard you are well versed as far as buprenorphine goes.

I have tried to start suboxone several times, but have either started too early (precipitated WD) or not lasted the 24-48 hours until the first pill.  I took my "last" shot of H yesterday morning at 9 am and then took 16mg sub when I woke this morning, so ~24 hours.  The subs did NOTHING, in fact after a couple hours my symptoms seemed to get progressively worse.  Even though I was advised to muscle it out, the physicial pain was too much and I bought another bag of dope.  It was suprisingly potent (since I thought my recepters should be pretty jammed up).  Anyway, despite not being as potent as usual b/c if the bup, the heroin cured 90% of my w/d symptoms instantly, creating a very bittersweet feeling.  It has been about 3.5 hours since and I can definitely tell that my body is metabolizing the heroin much faster than normal...ie I am no longer drowsy and the euphoria has subsided.  With the amount of heroin used, this wouldn't normally happen for at least 6 hours.

So I currently have 16 mgs of bup in my system from this morning and the heroin from 3.5 hours ago.  I really, really want to get stable on the bup and never do heroin again.  When should I take my next dose of bup?  Clearly the initial 24 hours was too little.  However, since I dosed the suboxone this morning (patialy inhibiting the dope), would tomorrow morning be too early?  I would think it wouldn't be since the bup blocked a lot of the dope - so there should be much less 24 hours later, right?  Please, please help.  Any light that can be shed on this would be great.  

[J T Junig, MD PhD]

If you do have precipitated withdrawal, you want to just keep taking the prescribed dose of Suboxone each morning-- usually 8-16 mg per 24 hours.  I was recently at a meeting with 70 docs who work extensively with Suboxone, going over the 'best practices' for the medication;  some start patients at dosing once per day and stay that way (I do it that way) and others start patients at twice per day and 'work them' down to once per day.  

My recommendation is usually for 8, 12, or 16 mg (depending as much on the affordability of the medication as on other factors) once per day, in the AM.  I recommend some differences in dosing from the sublingual approach;  if you search at my blog, suboxonetalkzone.com, using the phrase 'optimizing absorption' you will find a long article on the topic.
  
Precipitated withdrawal is much shorter than 'real' withdrawal.  If you take your reguarl suboxone dose it will pass in 2-3 days.  If you take more of an agonist or more Suboxone, you will prolong it for complicated reasons.  For example, there is evidence that in very high doses buprenorphine acts like an antagonist!  

So... be patient, dose each morning, and wait for it to pass.

[werdna]

oh mousie do I wish it were that easy...

I am very well educated on the sublingual dosing and the potency, etc.  

I was clearly not hard enough into WD.  I have been on $300 of heroin a day for the last 6 months and have been off and on opiates (mostly on) for over 4 years now.  So my withdrawal symptoms are EXTREMELY harsh.  It's crazy to think that even though my stomach was cramping, I was cold sweating, body was flushing, yawning, getting chills, aches, and sneezes, I was still not quite far enough into WD to induct into Sub.

I am going to try again and this time I will wait 36 hours no matter how I feel.  WIsh me luck!  

[Mousiee]

Hello,
I am not a doctor, obviously, but I was very surprised to hear that the Sub did not work for you.  I was once given one by a friend and without reading the instructions, I just swallowed it, like a normal pill and it did nothing.  These pills need to be dissolved under your tongue, which I didn't know at the time.  When taken like a regular pill, they have little to no effect at all.  I just cannot imagine the sub not working!  The first time I took it, all my withdrawl symptoms were gone, nonexistent.  The stuff does work;  it saved my life.  I am not saying that you were lying about whether or not it worked, I just thought maybe you didn't read the dosage insructions.

Good luck to you and congrats on getting clean!
Mousie