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Unread 03-02-2013, 07:16 AM   #1
cagedbird
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hi, ive been taking subutex for well over a year now
i was taking 8mg for the longest period of that time and because of back pain the dr insisted i go up in dose, im now prescribed 14mg which is take home weekly
my problem is i find it hard to stick to 1 dose, i have a problem where if i feel down or depressed i just take more, never more then 14mg though, even though i know it wont give me any good effect or any pain relief
now 2 days ago i took 8mg in early morning, yesterday i took 2mg x 2, 6 hours apart, so 4mg in total
today i have taken 2mg at 10am
my biggest problem lately is im sleeping 20hours/24 hours/18 hours, usually during the day, this is uncommon with me, i use to get energy after my dose and my depression lifted, but not anymore, im just tired and down, so if i stick to 2mg, twice a day, 6 hours apart, will the sleepiness stop???.
will i get better moods with the lower dose, as ive read many times the best anti depressant effects are at 4mg and below
right now i have no life, im sleeping during the day and half of the night, im also missing important appointments.
so am i doing the right thing in lowering my dose like this, if i feel any withdrawals i,ll simply take 2mg more and see if it subsides, but i feel like im going round in circles with these higher doses and im at my wits end
all i want is to feel like i use to,more energy,no pain, mood lift, which is what i had when i was taking 0.9mcr, of injectable buprenorphine.

thanks for taking the time to read.

george.
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Unread 03-02-2013, 07:33 AM   #2
NancyB
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Hi George, chances are if you stick to one lower dose, you will feel better. Being tired for no real reason is generally one of the first signals that the dose is too high. Then with you fluctuating your doses, that just adds to it because of the long half life. You never stabilize and that can make patients feel pretty crappy.

You said: "im now prescribed 14mg which is take home weekly
my problem is i find it hard to stick to 1 dose, i have a problem where if i feel down or depressed i just take more, never more then 14mg though, even though i know it wont give me any good effect or any pain relief"


Are you in counseling at all? If not, please think about it. That's one of the addictive behaviors you want to break. You want to learn how to deal with the depression in ways other than taking more -tex. Plus you don't want to look for more energy or a mood life. The bupe is only supposed to stop withdrawals and cravings at the patient's right dose.

Were you taking the injectable bupe for pain?

Give taking the same amount each day a try. It may take a few days to get stabilized on that dose- because the halflife has to work it's way out - but hang in there and then re-evaluate. If you start thinking that you 'need more', try to sit down and think it through or distract yourself by doing something else.

I hope this helps.

Nancy
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Unread 03-02-2013, 07:55 AM   #3
cagedbird
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thankyou nancy
yes i did take the injection for pain, aches, back ache, and i didnt realise that it would have such a pronounced effect on my severe depression
i finally saw for myself what happiness really is for the first time in my life and its hard not to want that mood lift again, i just felt pain free, normal and happy, not high or euphoric in any way
and you are right about the councelling, only i do make appointments but because lately i sleep so much i miss them which gets very frustrating, but hopefully with a lower dose this will subside.

in your experience and the info you know, how long do you think it will be before i feel the effects from the reduction, i took 8mg, early in the morning 2 days ago, and yesterday i took 4mg, yesterday and i,ll end up taking 4mg today hopefully.

also i went to the doctor and said about me sleeping too much, and my depression and lack of appetite and she has prescribed me mirtzapine an anti depressant, i got this a week ago but im quite scared to take it to be honest because i looked it up and see that it knocks alot of people out and acts like a sedative aswell, and because im sleeping so much as it is im worried that it will either keep the sleepiness the same or make it even worse, its only a low dose of 15mg
i dont really have much faith in anti depressants as ive tried so many but in fairness i probably dont give them long enough to work and the fact they say u will likely feel worse and even suicidal before you start feeling better also puts me off taking them
the only good effect ive read from this anti d, is the increased appetite
i just dont know why a dr would give me something that causes sleep when ive been sleeping as much as i have, i feel like its all my life revolves around.

thankyou for listening

george
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Unread 03-02-2013, 10:38 AM   #4
NancyB
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Hi again George, it could take a few days for the halflife (around 37 hours) of the higher doses to leave your system. But you have to stick with the 4mg consistently. Hope you don't mind my asking, how many times did you take the injectable bupe a day?

I looked up the mirtazapine here:
http://www.nlm.nih.gov/medlineplus/d...s/a697009.html

It does say that it's generally taken at night. Probably because it could make you sleepy. I think it's a good idea to get your bupe stabilized before trying it so you can see where the sleepiness is coming from.

I hope you start feeling better soon. Keep us posted please.

Nancy
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Unread 03-02-2013, 11:39 AM   #5
Leo
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Hi George

I am not a doctor but I would like to point out that Mirtazapine at 15mg will probably knock you out completely. It's a very powerful sleeping agent when first taken. However, when I was on it I found that the sleep inducing effect of the drug subsided after a few weeks. I found that it was very good at helping me think straight and, yes, eat well. As I say, I'm no doctor just giving you my own experience. But most people who take it found the sleep effect very strong at first. For me I found it stronger than the benzo's.

When I have changed doses of buprenorphine, like yourself, it really messed my body and mind up. This stuff must not be messed with. If you want to get stable and, perhaps, get off it in the fuiture then this is a must. Also if your messed up mentally, as buprenophine can do if messed with then counselling wont be as effective.

Best wishes George.

Leo
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Unread 03-02-2013, 05:33 PM   #6
gotoffmdone
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You taking Subutex I see. I too was taking Subutex for a long time but the generic I was taking negatiely impacted me. I never could get stable on any generic but Teva so I switched to the strips and paid a lot more money just for that reason. Now Teva generics are back.

You say you get a weeks worth. You going to a Dr and getting a script or to a Methadone clinic that provides Sub. If it is the latter you take whatever brand they give you.

wayne
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Unread 03-03-2013, 03:43 AM   #7
cagedbird
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yes i go to the pharmacy, and they are named brand
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Unread 03-03-2013, 03:49 AM   #8
cagedbird
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Quote:
Originally Posted by PollyParrot View Post
Hi George

I am not a doctor but I would like to point out that Mirtazapine at 15mg will probably knock you out completely. It's a very powerful sleeping agent when first taken. However, when I was on it I found that the sleep inducing effect of the drug subsided after a few weeks. I found that it was very good at helping me think straight and, yes, eat well. As I say, I'm no doctor just giving you my own experience. But most people who take it found the sleep effect very strong at first. For me I found it stronger than the benzo's.

When I have changed doses of buprenorphine, like yourself, it really messed my body and mind up. This stuff must not be messed with. If you want to get stable and, perhaps, get off it in the fuiture then this is a must. Also if your messed up mentally, as buprenophine can do if messed with then counselling wont be as effective.

Best wishes George.

Leo
and yes i agree with you i,ll hold off taking the mirtzapine as ive heard it does knock you out, you see i was awake all day when i posted the original post, and ive been awake since, i just dont get tired at night times anymore, its now quarter to 8 am , and ive still had no sleep and if i di i,ll sleep the whole day, and if i wait til tonight i,ll sleep the night and day, i just dont get this at all, my mind is so foggy, and i cant even easily remember the usual times i take my dose, i,ll try to make a conscious effort to dose 1st thing in the morning and thats it, even though its the fourth day could i still be adjusting to a lower dose hence why my sleep is so messed up, sometimes i feel like going 5 days with no sub and into withdrawal just to feel the subs work better once again, only i can never last that long
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Unread 03-03-2013, 07:24 AM   #9
NancyB
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Hi George, I think you have a good idea in waiting to go back into withdrawals and start again. But since you noted that you don't last that long, have you thought about reducing your dose from 4mg to 2mg and see what happens with that? Maybe give the 4mg a couple of more days and if you don't notice anything, think about trying 2mg.

How many times a day did you take the injectable bupe?

Nancy
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Unread 03-03-2013, 10:01 AM   #10
cagedbird
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hi nancy,
i only injected once in the morning i.m in the glute muscle and it was only 0.9, so just under a mg which i think is roughly around 2mg sublingual
this morning i took my 2mg dose and even on 2 hours sleep, i feel somewhat better, i dont wanna jinx myself, but i definately feel better then yesterday and the many days before that on higher doses.
i could always take 2mg more later only if i feel the need to but i,ll definately be sticking to no more then four mg daily for now.

would you be able to answer this;
do you think i feel better on low doses because the bupe has more of an opiate effect, from what ive read bupe acts or is a full agonist at 2mg per day, and u also feel the medication more because of the drop and spike of bupe in your blood concentration, ive heard at 2mg a day it converts to norbuprenorphine which is infact a powerful agonist, and i wonder if this is why at low doses it helps people for depression and pain relief, i know from my own experience on 0.9mcg i felt way better then when i was on 16mg, infact 16mg caused me to go cold turkey and have the worst withdrawals of my life until i went back on it.
ive never really been an opiate addict,luckily i got on subb pretty quickly when i started to abuse opiates, ive only done oxycontin 80,s for maybe a week on and off in total and morphine timed release which never effected me whatsoever, and then after that my drug was actually buprenex injectable, just straight bupe, which ive felt the best ive ever felt,
i will definately take your advice and give it a couple of days on four mg and then switch to 2mg, if i feel like i need to go into withdrawals and go that route i,ll certainly check in here for support as this is a great easy going non judgemental site, and ive read many of your posts and your always willing to help and u understand this complex drug, so thankyou and i,ll keep u posted.

have a nice day.

george.
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Unread 03-03-2013, 03:40 PM   #11
gotoffmdone
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You are getting NAMEBRAND Subutex. I thought they were no longer being made. Just curious

wayne
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Unread 03-03-2013, 07:46 PM   #12
NancyB
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Hi George, I wonder if because you only had the bupe once a day, if all this excessive sleeping is being caused by the dose of sublingual bupe you're taking. That seems to be a big jump in dose from once a day 0.9mcg. 2mg might be all you need. Or if necessary, break it up 1mg and 1mg if you need more pain relief through the day.

Let us know how if you stayed at 2mg and how you feel.

Nancy
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Unread 03-03-2013, 07:48 PM   #13
NancyB
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Quote:
Originally Posted by gotoffmdone View Post
You are getting NAMEBRAND Subutex. I thought they were no longer being made. Just curious

wayne
Hi Wayne, I believe George is in the UK because he mentioned talking with his keyworker in another post. They still have -tex there. Just not here...

Nancy
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Unread 03-04-2013, 08:18 AM   #14
cagedbird
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hey everyone, yes nancy you are right, im in the uk and ive always had the same brand of subutex,
yesterday i was kinda dissapointed with myself because i ended up taking 6mg, but it was more to gauge the effects and to see if anything was to gain above 2mg and my findings is a firm no, none whatsoever.
and i really didnt feel any different taking four mg, but im not sure if thats because i took it before having chance to feel low,
ive been trying to work this drug out since i got on it and ive never known such a complex drug, i,ll admit i have used myself as a guinea pig, but i dont regret it because ive started to know 1st hand what works and usually what doesnt work more importantly
so although i slipped up yesterday and took an extra 2mg, im not gonna beat myself up over it, im only annoyed because i knew at the back of my mind it wouldnt help and yet i still done it, but hey today is a new day and for once we have sun in the uk
now over on another site there is a well known dr junig and he states the ceiling effect for opiate effect is four mg, but ive also read its 2mg and another place 1mg, i think this is the problem i see so many conflicting reports on this drug its hard to know whats right or whats wrong.
so my goal right now is to take what nancy said 2mg/ 1mg twice a day and i,ll give that until friday to see what is best, its just hard thinking that you get better effects from a drug by taking as little as possible.

george.
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Unread 03-04-2013, 01:35 PM   #15
gotoffmdone
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That was going to be my next question but I hit the post it button to quickly.

But isn't RB the only one that mfg the brandname.

I wonder if they do not have generic Subutex in the UK.

In the US people with insurance could still get the brandname couldn't they? If so, I was curious as to why RB d/c here. I guess i was just under the impression that the brandname did not exist anymore, anywhere.

wayne
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Unread 03-04-2013, 03:47 PM   #16
cagedbird
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i just checked they are definately r b
i pick up from a high street pharmacy and this is the only brand they stock, the only thing that has changed is the blister pack, for safety measure i presume because they are a little harder to get in to.
and as far as im aware they do not do the films here, patches yes but not film
they do suboxone here and im not sure who makes that as ive always had subutex but i was offered suboxone at one point starting treatment

i just looked about about the discontinue of r & b sub, here is a link
http://janaburson.wordpress.com/2012...oxone-tablets/
apparently they stopped the tablets due to accidents with children taking them, so maybe because of the size of the uk it isnt as much of a problem here.

george.
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Unread 03-04-2013, 04:20 PM   #17
TIM
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Quote:
Originally Posted by cagedbird View Post
..
would you be able to answer this;
do you think i feel better on low doses because the bupe has more of an opiate effect, from what ive read bupe acts or is a full agonist at 2mg per day, and u also feel the medication more because of the drop and spike of bupe in your blood concentration, ive heard at 2mg a day it converts to norbuprenorphine which is infact a powerful agonist, and i wonder if this is why at low doses it helps people for depression and pain relief, i know from my own experience on 0.9mcg i felt way better then when i was on 16mg, infact 16mg caused me to go cold turkey and have the worst withdrawals of my life until i went back on it.
ive never really been an opiate addict,luckily i got on subb pretty quickly when i started to abuse opiates, ive only done oxycontin 80,s for maybe a week on and off in total and morphine timed release which never effected me whatsoever, and then after that my drug was actually buprenex injectable, just straight bupe, which ive felt the best ive ever felt,
i will definately take your advice and give it a couple of days on four mg and then switch to 2mg, if i feel like i need to go into withdrawals and go that route i,ll certainly check in here for support as this is a great easy going non judgemental site, and ive read many of your posts and your always willing to help and u understand this complex drug, so thankyou and i,ll keep u posted.

have a nice day.

george.
Hi George,
A good way to picture how the bupe works at different doses is to think of it in terms of math, the number of available mu-receptors. At low doses (below 2mgs) there are lots of available opioid receptors for the bupe to bind to and cause an opioid effect. Even though that opioid effect is much smaller than what full agonists produce, because bupe has such a high affinity it attaches to many more receptors than an equal dose of full agonist so the net effect of all of those partially turned on receptors adds up to a substantial effect, when compared to an equal dose of other full agonist. Think of affinity as magnetism for the mu receptor, and bupe has very strong magnetic attraction while full agonist have a weaker attraction. So an equal dose of full agonists, will fully trigger the mu receptor but many less receptors are affected as compared to bupe. This is why it appears that bupe is more potent at lower doses when really its just that more mu-receptors are involved. At higher doses, the amount of available receptors decrease leaving less receptors to bind with and less net effect. At ceiling doses and above there are no more available receptors so there is no more additional effect, this makes it appear that bupe is suddenly less potent, but really it just can't elicit any additional response because there are no more available receptors to bind to. This is also why bupe blocks full agonist opioids at or close to the ceiling dose, because there are just aren't any available receptors for the opioid to bind to. This link shows mu-receptor availability at different doses:
http://www.naabt.org/images/petscan.jpg

As for you specific situation, I think the standard advice is appropriate here too, find the lowest dose that both suppresses cravings and withdrawal. This dose will change with time and behavioral changes and by decreasing by no more than 25% at a time, allow your body time to adjust and with time the dose will be so small that it no longer has a perceivable effect.

Hope you find this helpful,
Tim

as for depression and bupe, i think it may have more to do with how bupe works on the kappa receptor- this link explains: http://www.naabt.org/documents/The_B...Depression.pdf
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