1. Hume

    I was just beginning to abuse opiates when my mother died. Beyond her leaving around fifty left over 80 mg oxycontins from her own medical issues, I was was given about one hundred thousand dollars in life insurance money from her death.
    I had just begun to use pain meds habitually when she passed, and dealing with her death I went into overdrive. Within 2 years I had spent almost the entire $100 thousand dollars on opiates. If I only knew about buprenorphine at the time, and it’s miraculous effects on me,…
    Now I am laid off and living on unemployment, barely enough to survive, but at least I am free from the emotional hell of opiate addiction. The regrets are enough to cause physical pain, however. Losing my mother at such a young age was devastating, and I don’t know how I would have dealt with it without the narcotics.

    • Regrets and resentments are by far the biggest issue that I hear about– and the issues I struggle to deal with as well. I talk to people all day long who lost huge sums of money, businesses or jobs, and other possessions. People have an even harder time after losing boyfriends and girlfriends– people who the addict NOW realizes was a wonderful person… who will never trust the addict in the same way, no matter how many years of sobriety. Then there are those who lost children and spouses– again, a horrible thing to deal with.
      I’ve consistently writtten about my belief that step programs are not enough for opiod dependence. At the same time, there is certainly a place for step-based recovery. Twelve step programs help one learn to deal with resentmens and other feelings (guilt and shame for example). The question is whether a person on buprenorphine can ever find enough desperation to be motivated enough so that the steps work. I strongly recommend at least trying a few meetings if you haven’t already. They are ALWAYS sort of a bummer the first few times, until you get to know a few people (and find the right meeting for YOU). Understand that real change will always feel uncomfortable, and will always be rejected; if you immediately accepted something, it would not be ‘change’!
      Bottom line– resentments and regrets are life-killers. You deserve to let them go; I hope you find a way. Be sure to try on the forum as well (suboxforum.com); you might find some useful information there about how others deal with those feelings.

  2. tic

    One concern that I have about low intensity users is that they will escalate their use over time, and other treatment methods have such a low rate of success. Is there any rational for using low dose buprenorphine 2-4 mg in low intensity opiate users?

    • I share your concern– I think that the main thing in regard to dosing is that the person has to take a high enough dose to get on the flat, horizontal part of the dose/response graph. At low doses, buprenorphine essentially acts as an agonist, where increases in blood levels cause in increase in opiate effect and decreases cause cravings and withdrawal. It is only when the person is beyond the ‘ceiling’ that the unique actions of buprenorphine come out– i.e. as the blood level drops between doses, the opiate effect remains constant, preventing the development of cravings and the obsession to use.
      Because of the ceiling effect, a person’s tolerance does not change all that much as the dose is raised from 4 to 16 mg. Both doses have similar opiate effects, meaning similar tolerance levels. The main problem with being on higher doses of buprenorphine is that it becomes much higher to overcome receptor blockade in the case of injury or surgery.

  3. whiskey fish

    How long does it generally take to taper someone off 10-20 mg a day of hydrocodone using Suboxone? I understand that each case is different and it depends on how much of the withdrawals a user is willing to expierence, but how long would you say? I’ve gone cold turkey before and after about 6 days I was starting to feel better.

  4. To be honest I probably wouldn’t use Suboxone for that situation. The opioid activity of even a quarter tablet of Suboxone is much greater than 20 mg of hydrocodone; in fact, it would be similar to about 80 – 100 mg of hydrocodone. So you would be taking a huge step up the tolerance ladder by taking buprenorphine. The ceiling effect of buprenorphine would make it very difficult to use even a very small dose of buprenorphine; you would have to take maybe 1/10th of a tablet to start the taper, and even that would probably cause a significant opioid ‘buzz’ that would push tolerance in the wrong direction.
    20 mg of hydrocodone is not a high dose by most standards; in my practice the average dose of addicts seeking treatment is between 100 and 400 mg of oxycodone per day, with the highest up around 800 mg per day of oxycodone. Hydrocodone is weaker than oxycodone; 20 my of hydrocodone is about as potent as 12 mg of oxycodone. So I would recommend going ‘cold turkey’ from your current level, and I would think that by the end of the week you’ll be OK. Of course, the problem most addicts have is STAYING clean, not GETTING clean.
    Good luck,

  5. Jason

    I wholeheartedly agree with your statement “Patients have a right to know if they are having their tolerance increased in my opinion, given the misery involved in bringing tolerance down. It is also important to tell people with lower tolerances that they are going to get a buzz from buprenorphine for a few days because of the potency of buprenorphine.”
    As I’ve detailed in a post on another one of your blog entries, I was not informed of the effect on tolerance nor the drugs poor analgesic capabilities when compared to a a full agonist of less potency. I was on an even lower dose than JJ’s 20mg… I was on 5mg, twice a day (10mg total) for three months. I’m not sure what the doctor saw in my medical history… but he did have my urine sample to validate any toxicology findings. Whatever he saw, he recommended the 2mg strips, which as you said, caused a significant opioid high. I never had a feeling remotely close to that on the hydrocodone. I’ve now been on Suboxone for almost three years.
    I only wish I had researched the medication before starting it… maybe I would have found your site and read these recommendations.

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