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  1. #1
    mrsbaby is offline Junior Member
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    Default Taking pain medication while on Subutex?

    Hello everyone. This is my first time posting, but I have been reading everyone's posts for the past few days---which has been very helpful, so thank you all!!!!!! I have been taking Subutex for a little over a month now (started with about 4 mg's a day and now taking anywhere from 1mg-2mg). I'm actually on my second prescription--but after reading everyone else's horror stories, it's kinda got me wondering if I should have tapered off sooner. I have gone a couple of days without it at times, but still felt minor w/d symptoms. My addiction was Percocet and I would take about 15 10/325's a day, or anything I could get my hands on--Vics, Oxy's. I have not taken the Subutex in about 24 hours and I wanted to know if it is possible to take a Percocet for pain? Would it make me high (which I am trying to avoid)? Would I have to wait for the w/d's again to begin taking the Subutex? Also, I am scheduled for surgery soon and I am not going to be able to go through all that pain. I just want to know what I'm up against here and what would happen if I was to take a Percocet. After reading everyone's advice, I'm convinced that someone could help me out here. You all seem very knowledgeable!!!!! Thank you all and have a great night!!!

  2. #2
    mrsbaby is offline Junior Member
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    I see that alot of people have read this, but no one has replied... Can someone give me some kind of advice. Im nervous because I have to go for surgery and I was told it is going to be very painful. I just need some advice as to when the Sub will be out of my system (how long after the last dose). I hear all different time frames--one year, one month, three days, 24 hours...Not sure what the right amount of time is. I dont want to become addicted again (to the percs) but I dont want to be in pain either. Someone please help!!!! [V] Thank you and have a great night everyone!!!!

  3. #3
    spar7an117 is offline Member
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    MrsB.

    Many misconceptions state that pain-relief seeking patients are in fact addicted. This is not the case. The best answer would be to speak with your treating Physician and agree to a course of action that will treat your pain effectively. This is not medical advice but it is based on a clinical study recently printed in the Annals of Internal Medicine**.

    Opioid Induce Hyperalgesia is a condition that develops due to the presence of high levels of abused opiates. The result of neuroplastic changes in pain perception can lead to an increase in pain sensitivity. Recommendations in the study for pain in a Bupe patient are the following:

    1. Continue Bupe therapy and titrate a short-acting opioid analgesic to effect
    2. Divide the daily dose of Bupe and administer it every 6-8 hours to take advantage of the analgesic effects
    3. Discontinue Bupe therapy and treat the patient with full scheduled opioid analgesics by titrating to effect to avoid withdrawal and then to achieve analgesia.

    **Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy Annals of Internal Medicine 2006. Alford D, Compton P. 144:pp127-134

  4. #4
    spar7an117 is offline Member
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    Active Bupe stays in the system (binding and affecting mu receptors) for approximately 37.5 hours. It may vary from patient to patient but the analgesic effects have been reported to block other dosed opioids for at least that timeframe. The only drug that will displace Bupe is Fentanyl, a fully synthetic super-agonist that chemically mimics opioids but is not derived from any narcotic. It will displace Bupe in the system and result in instant effect, which is why it is used in ambulatory emergency pain situations for patients brought into the ER or for emergency surgery.

    However, lower doses of Bupe will not totally block all opioid effects. In order to achieve full saturation and blocking of dosed narcotics, an average dose of 16mg of Bupe must be dosed to block approximately 95% of the available mu receptors in the brain. If you are given a lower dose (of Bupe), although patient response may vary, Doctors may use other opioids to treat pain. Most Physicians usually use a higher Bupe dose but administer it using a full agonist schedule, either 3 or 4 times a day to take advantage of the pain-treating effects.

    I hope this information helps. If you need anything else, post other questions and I will try to answer them. Your best bet will be to speak with your treating Physician, Surgical Specialist, and after-care case manager to create a plan that will keep you as comfortable as possible.

  5. #5
    Bup4pain is offline Senior Member
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    "The only drug that will displace Bupe is Fentanyl"

    Do you have any data to support this.. Affinity #'s on some scale...

    Gee, ya think 16 mg of sub being the full blocking dose is why so many people are on that amount even if they don't REALLY need it??? Forcing more meds on people then they need.. all this does is increase your dependence on opiates... Tolerance, dependence and lower their chance of *ever* getting off of ALL opiates. Let alone the changes being on this amount of bupe will cause long term in the brain.

    Fentanyl is some crazy stuff.. the Militarized/weaponed forms sure work! Just ask the Russians. ;) Don't work so well on an addict LOL... but on the opiate naive slam dunk!

    Been there, done that, wore out the tee shirt.

  6. #6
    ILLSUBREAL is offline Senior Member
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    Spar7an117 & Bup4pain, Both you guys are highly knowledgable in the opioid therapy replacement, dependency area. You guys and Ratch (where ever did he go?) are very well versed and know more than most Dr's do in this area! So, I have a couple of questions for you and anyone that can help me?

    1) I've been @1mg/day (.5&.5) for past 7 days and wonder if you could layout a simple finishing taper? I've been going down .25mg since 2mg. I dose at 11am and 8pm (not currently working) and look forward to getting this 'bear' off my back. I have clonidine .2mg #30, diazepam intensol, (I'm not benzo nieve, I've taken alprazolam for-7+yrs) #30 Prop-N 100/650 APAP Rx'd for acute post-bupe days, ~4-14 (I'll take only if truley needed. The Tylenol will help with any fever and or small aches). Also, I have #25 50mg Tramadol left over from a work-related injury (they are probably out of date-05').

    I started out very high on bupe because of 'Methadone MT' (3.5years). I got on 'MMT' after about 1.5 years of very high OxyContin use.

    I detoxed off of OC's once in the beginning and it took me about 5-7 days and I was a good as new but got sucked back in because of back pain. I know alot about Bupe detox but haven't done it yet (could get lucky)! I'm in the best shape of my life, lots of cardio, free wieghts, vitamins and plenty of calcium. I'm hoping 'my' acute phase won't be so bad (I want to get down to .25mg for 1 week and jump).

    Btw,
    I've also just been 'dx' as 'ADD' at 32 yrs. of age and am working with that the best I can but I won't lie and say that I'm not scared of losing the focus & energy bupe gives me! I may have to resort to a stimulant before going back to work. Anyway, any insight and/or experience from you guys or anyone would be very much appreciated. Thanks everyone! Good luck to everyone!

    ILL

  7. #7
    ILLSUBREAL is offline Senior Member
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    I guess its good to see your thoughts spelled out (which I obviously did lol)! I need to keep moving forward and everything should fall into place (detox-wise)? From reading my own questions and also answering them in the same post, (haha) I realize now that I'm ready for this to be over and hopefully prepared? lol...Good luck to all working on thier taper and detox's!

    ILL

  8. #8
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    sudokudee is offline Senior Member
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    Hi, Illsubreal.

    I don't know if I missed it. Did you say how long you've been on sub and when you started tapering?

    In any case, when I tapered off sub, I did pull a razor blade out of a safety razor in order to cut the final doses into the tiniest of pieces.
    I don't really know if the exact length of your taper is that critical. I would definitely wait for any discomfort to pass and for your body to stabilize each time you do another drop.

    You have excellent comfort meds there so you should do great thru the initial detox period. Especially the clonidine and the darvocet. I would see how drowsy the clonidine makes you before you add the valium. You may not need it. Don't wanna put you in a coma.

    The persistent lethargy, sleep stuff, low motivation, etc. you may experience is something you basically have to tolerate until they improve and hopefully, disappear.

    Love, Dee

    Dee--off MMT 9-12-06

  9. #9
    ILLSUBREAL is offline Senior Member
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    Sudokudee, I've been hard-tapering since about 2mg (been on bupe for 16.5 months) ACK! Started at 64-72 mgs/day! But I'm very commited to this detox and just want my 'real' life back for good. I dropped down to .75mg/day (pm dose is .25mg and am dose is .5mg). I appreciate your reply and support very much. I need to start my Taper/Detox thread very soon. I've been posting over in Darkdaze's thread. She and I are very close in dose, so we kinda lean on each-other for support and information day to day. Do you know if 'RLS' is pretty much a given post-bupe? I seem to be getting it a bit already? The Clonidine should really help with that I've heard? So, what dose do you think is low enough to jump from safely? .5mg? I always read your posts and can relate to alot of what you say about 'MMT'. I was on Methadone for 3.5 yrs and OC's before that. I just wish I would have been properly informed about bupe before I made the transition, which sucked.

    Anyway, thanks again...Take care!

    ILL

  10. #10
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    sudokudee is offline Senior Member
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    Hi again,

    Wow, that was a whopper dose of sub they had you on initially!! I don't know, that may be the highest I've ever heard of! Good job on tapering it down so much!

    Clonidine worked really great for me both for methadone and for sub. It literally knocked out the withdrawal symptoms plus practically knocked me out. I totally believe now that it is excess release of noradrenaline that causes all the misery as every time my symptoms cranked up, sure enough my pulse and blood pressure would shoot up and the clonidine, which decreases the noradrenaline, almost totally relieved everything.

    You have great comfort meds there, honestly. You should have it made. Can you take some days off from work? The acute part only lasted about a week, relieved much by clonidine. Then, of course, you will have to deal with not feeling quite 100% for a little while longer.

    DD also has good comfort meds but her problem is a neighbor who supplies her with sub. Always good to have no source of re-supply--too tempting.

    Love, Dee

    Dee--off MMT 9-12-06

  11. #11
    ILLSUBREAL is offline Senior Member
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    Sudokudee, Yes, I have 'some' time away from work right now and feel like its time to end of my stay on bupe. I really want 'life' to be 'life' again, even though it won't be easy, it will be 'real'. Like I mentioned before, I'm 'dx' ADD/ADHD and have delt with it for 20+ years and am just now learning some really interesting things about myself (whole different BOOK).

    Honestly, how 'bad' is the anxiety during the acute phase (or just not feeling comfortable in your on skin deal)? I usually expect the worst and hope for the best...just the way I look at these types of situations I guess? However, your support and input is helping me with my resolve as I type this post! I'm just not sure when to jump (I'm sure I could in a week if I wanted to but I want to minimize WD as best I can? I know I have to pay the 'piper' and we are all different, so, I try and stay positive and hopefull through this taper/Detox.

    Thanks for any input once again...

    ILL

  12. #12
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    sudokudee is offline Senior Member
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    Well, let's see. I never took sub twice a day so I'm a little unsure how that would work. I would think you would have to taper down to once daily at some point, right?

    I think the best I could do with a razor blade was to divide the 2 mg. tab into sixths. What would that be? Like 0.33 mg.? Anything smaller would just end up getting crushed into powder.

    I think I took that for about a week and then jumped.

    What I think I would do is to use the clonidine initially and perhaps save the darvocet, or at least some of them, for after the acute detox part. I don't really recall much pain initially. More anxiety, malaise, restless extremities, crackly skin.....all of these greatly ameliorated by the clonidine.

    I didn't really feel true anxiety. It's just that when your pulse and BP shoot up from the noradrenaline, it makes you feel like you are speeding on the inside and wearing a lead suit on the outside.

    It's more of a physiologic "speediness" that causes this type of anxiety. Like your heart is racing, you can't relax, etc. Clonidine is really great for this.

    You know, I didn't expect to feel great and function normally. Just didn't want to suffer. The clonidine eliminated most symptoms that would have made me suffer.

    Later, for achiness days, you could use the darvocet sparingly.

    Are you on meds like ritalin or adderall for your for your ADD/ADHD?
    If you are, this should counter-act some of the long-term fatigue.

    Love, Dee

    Dee--off MMT 9-12-06

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