Thread: Where to start.
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Unread 04-20-2017, 01:58 PM   #4
NancyB
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Hi again, the blocker is actually the buprenorphine itself. Naloxone, which is in Suboxone, Bunavail, Zubsolv and the generic Suboxone is only there to deter IV use. Otherwise it's considered 'clinically insignificant' UNLESS injected.

This explains how bupe blocks the receptors:
http://www.naabt.org/collateral/How_Bupe_Works.pdf

It's hard to say, but it kind of sounds like you weren't given enough bupe, or you weren't in enough withdrawals. We've had people here before who were taking large amounts of heroin need more bupe than what you took. Another factor, which you might not even know, is if the heroin was cut with fentanyl, that complicates an induction even more because of the strength of fentanyl and the affinity to the receptors.

Another thing is that some people here have had less success with some of the generic bupe-only products. They didn't seem to get as much absorption as they did when there was brand-name Subutex (bupe only). So if you weren't getting optimal absorption, that would mess things up too.

If you were to try it again, waiting to be in more than mild to moderate withdrawals could help and to take more bupe, maybe 4mg to start and increase 4mg every couple of hours to get your bupe blood levels up more quickly. That's been done in cases like yours and also for people transitioning from methadone to bupe.

This is a pretty good link on precipitated withdrawals - especially page 2 which has the clinical opiate withdrawal scale.
http://www.naabt.org/documents/NAABT_PrecipWD.pdf

I hope this makes sense?

Nancy
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