Continued from 4th post: (yep...this is a loong one)

Buprenorphine withdrawals:

Bupe withdrawals are mild at best (in comparison to other opioids.) For this reason, it is a great thing for people wanting to get off 'done but unable to deal with the withdrawals. Unfortunately, due to it's long receptor half-life like 'done, the withdrawals will last at least a month (although this too is individualized, and can be shorter.) Bupe has one major unique symptom of withdrawal that will be the centerpiece: this unbeatable fatique that will outlast all the other symptoms. All of the other symptoms, except a few minor and not worth mentioning unique ones such as stomach grumbling, are similar to other opioids. I have been told that the withdrawals are the worst during the first week and then proceed to lighten up alot. Once again, individualized.

It is strongly recommended you do NOT taper your dose really low before quitting. It doesn't work, and doesn't help. It'll make the withdrawals linger much longer. It is not a good idea. Reports of withdrawals cold turkey have been much more positive than taper attempts. (PROVIDE REFERENCE) The suggested dose to go cold turkey from is 4mg. Your body will take care of the rest (via the slow dissassociation of the drug from the receptor, lasting quite a long time, creating an auto-taper).

I must say however, as I have in just about every other section, this is individualized. There have been people who have had bad withdrawals from buprenorphine. In this case, a different strategy is warranted, *possibly* involving a longer and lower taper.

Treatment with Naltrexone (although strongly frowned upon by myself) is possible very early after the cessation of low-dose buprenorphine treatment, within days, and does not cause severe withdrawal symptoms. (Bell et al., 1999) This certaintly is individualized, and if you are in the rare situation of having bad withdrawals after stopping low-dose buprenorphine, it is a very bad idea. (ADD BELL)

Buprenorphine for detox:

Coming soon.

 

Subutex vs. Suboxone:

OK, alot of you hear "naloxone" and get scared. The fact of the matter is that naloxone is not absorbed sublingually. It is added so that people don't bang it. If you bang Suboxone, you will get very sick and will deeply regret it. There is no clinical difference between sublingual Subutex and sublingual Suboxone.

OK, now to get a little more technical. A tiny tiny amount of naloxone is absorbed. So little in fact, it wouldn't even qualify for ULD antagonist therapy (as told by my doctor, and Mike Strates, "inventor" of ULD Naloxone therapy, as I can't personally make sense of the numbers.) So, you ask, if it does nothing why are there two formulations? Quite honestly it's because the company wants more money. Supposedly the Subutex is supposed to be used for initiation so the naloxone doesn't cause withdrawals. Quite honestly, this is a crock of shit. The picograms you are absorbing is not going to make a difference to your withdrawals, it is downright silly. Doses of Naloxone at much higher levels have been shown not to cause withdrawals, so why would this ridiculously tiny amount do so? (PROVIDE REFERENCE)

The company decided to push to get Subutex approved sometime in the middle of the clinical trials. This is one of the reasons FDA approval took so long! It was the company that pushed for Subutex - no one else.

The difference in maintenance between Suboxone and Subutex is absolutely nothing. As someone who has taken both formulations for long periods of time at least twice each, I can personally say that from experience.

Now, the fact that you are getting a drug that has another drug merely in there to prevent you from shooting it IS insulting. It shows a real lack of trust. But it's not really up to the doctor. This is the way the USA is, and there is no way around it. So try not to think about it, and just take comfort in the fact that there is no difference, even though, alas, you cannot try and shoot it (you were thinking about it, weren't you? See, a lack of trust is warranted :P)

 

Practical information:

First and foremost - SUBOXONE IS 100% AVAILABLE. We are still waiting for the Subutex, with no promise of a date from the company.

Not every doctor is authorized to prescribe bupe. Any doctor who wishes to be only needs to take an 8 hour course, or meet any of the other easily meetable requirements. For this reason, I am positive bupe will be very easy to come by (in the near future.) When a doctor is "authorized" (s)he gets a second DEA number to be used for this purpose, which the pharmacy quite honestly has no way to verify unless they physically call up samhsa or the DEA.

Here is a link to the doctor locator: (Note: Not every doctor authorized is listed here. Not every doctor listed here is competent).

http://buprenorphine.samhsa.gov/bwns_locator/index.html

Sadly, even though Suboxone is available, and the DEA numbers are issued, that doesn't mean getting into the program will be easy. Doctors have little clue of what they are doing, nevermind what is going on. Pharmacies are skeptical of catering to heroin addicts. Let me address some of this.

SAMHSA has been spreading misinformation. They have been telling doctors that Subutex/Suboxone won't be available for three months. If your doctor doesn't know the drug (Suboxone, not Subutex yet) is available, have him call 1-877-SUBOXONE. This is the company's helpline, and they will tell him all about it.

Doctors are under the impression, thanks to Reckitt Benckiser (the company who makes Subutex/Suboxone,) that they should use Subutex for induction. There is no reason for this other than to be cautious for extreme hypersensitivity/allergy to naloxone. (See Subutex vs. Suboxone for more information on this.) Be sure to tell him that you are not afraid to be inducted with Suboxone. For this reason, and for many others, doctors do not have their induction doses, and probably won't for several months. This will delay the majority of buprenorphine maintenance a great deal.

There is a solution, and Reckitt suggests it themselves: have your doctor write a script for 3 8mg tablets or so, and then you can bring it back to the office for induction or the pharmacy could deliver it. (Suboxone full prescribing information.) If he is willing or prefers to do inductions with Suboxone, have him/her call 1-877-SUBOXONE. They will connect him to warehouses in order for him to get his induction doses.

Pharmacies are not going to have Suboxone in stock. They will most likely order it on a per prescription basis. This is even more the case because of it's price, nevermind it's use. Be sure to keep this in mind. Almost all pharmacies have next day delivery, provided that it's not backordered (which it's not at the current time.) You should have your doctor call in this induction dose the day before so it will be available. Then we come to the next problem. Pharmacies don't want to cater to junkies. Most will be very skeptical. In major cities, this really isn't an issue, but in rich/suburban communities, this can pose quite a problem. Be sure to call around and try to find a good pharmacy. A good pharmacy will make your life a whole lot better, and you should not quit until you find one. I suggest you try and find one before finding a doctor, as he may bring this up.

Moving on, here is a list of *approximate* prices. I have no idea whether your insurance will cover it, call them and ask. As of my last (and only) script for 'bupe, it came up as drug not found on my insurance. When further information is available regarding information I will provide it.

(These prices are for a month supply (30 days) at the specified daily dose. I have *roughly* extrapolated these numbers from the price of the 8mg daily monthly supply, and as such the other numbers are far from perfect. This can also vary regionally, and by pharmacy. Some pharmacies offer discounts, 10% for such a large cost is not uncommon.)

8mg  - $175

12mg - $250

16mg - $340

24mg - $510

32mg - $650

The average daily dose is 16mg. 32mg is NOT *necessarily* the best dose, due to pharmacological reasons, regardless of whatever your tolerance may be. (See "Bupe and dose" in the "Bupe Pharmacology" section.

Bupe comes in bottles of 30 and is available in 2 strengths: 8mg and 2mg, in both Subutex and Suboxone formulations. They will likely come in the original bottle for as much as your dose is divisible by 30.

The procedure for switching to bupe is simple. You go to the doctor's office the first 3 days where he administers a dose of most likely Suboxone. (S)he will likely have you in the office for 2 hours during the first dosing. The second and third days will be shorter. You will then go once or twice a week for the first month, and it is unknown how large a script you will be given. After the first month is up, you will get monthly supply scripts, once a month (obviously,) and will see your doctor (most likely) once a month for maintenance and once a week if you are recieving psychotherapy. Psychiatric fees are usually in the $200-300 range for one visit, at least in New York.

Buprenorphine is a schedule *III* (not V) narcotic under the controlled substances act. This was changed recently. Bupe most definetely deserves to be a CIII, and I believe the prior scheduling (via Buprenex) was automatic due to it's relation to thebaine, and has not been examined directly. (VERIFY)

There is one other formulation that exists: Buprenex. (as was just mentioned) They come in 0.3mg injection vials (possibly 0.6mg but i'm not sure.) They are very expensive I hear. It is important to note that Buprenex is NOT FDA approved for maintenance, it is approved for pain, and it IS illegal for that use (for your doctor (Special rules apply to opioid maintenance, see the first section). If you had a legit script, it's not illegal for you.) People have used it in desperation in the past, with mixed results, although generally the results are surprizingly favorable for such a small dose.

Overseas:

In some countries Subutex comes in an 0.4mg strength as well. This has no practical use except for PRN (as needed) use during induction. This will not be happening in the USA (the doctor will personally induct you for the first three days, making this dosage unnecessary.) It could possibly be used for tapering purposes, however the only reason why one should taper so low is if they are having unusually strong withdrawals from buprenorphine, which is uncommon. See the withdrawals section for more information.

There is also another formulation, Temgesic, but it isn't available in the USA. It's generally useless, and comes in 0.2mg and 0.4mg SL tablets. It's only use is for the same reasons listed above for the 0.4mg Subutex, and for pain, which is what it is approved for in the countries it's approved. It is interesting to note that Temgesic contains no listed inactive ingredients. I find it hard to believe it's nothing but buprenorphine, however, as 0.2mg is barely visible to the naked eye if it is at all (VERIFY), and on top of that handling the tablets could easily cause destruction of the drug. The reason why this would be worth mentioning is because it is almost asking you to inject it. There is also Temgesic-NX, which contains Naloxone just like Suboxone. You do NOT want to inject that under any circumstances.

 Continued in next post:

Source and credit to:

Nephalim of