This is some fairly hard earned information that some people should find informative. I had an Oxycontin habit, back before the WHOLE WORLD discovered MY SOC :-(, and finally figured I needed to straighten my life out. I actually cold turkeyed off a VERY high daily mg amount, but wasn't educated enough about PAWS to wait it out. So I ended up in a Methadone Clinic, until they drove me crazy with all their rules, regulations, etc... Big brother protecting us. So I "fired" them one day, and started tapering down rapidly because a transfer from Methadone to Suboxone from more than 60mg/day of Methadone is not recommended. My psychiatrist thought I should do it, but I figured why not taper and be more comfortable with it. 30mg is the target, but I jumped at 39mg/day of Methadone.
Bupe, Suboxone (8/2, 2/0.5) Bupe/Naloxone in the US, or Subutex (Only Buprenorphine in the US) is weird stuff. I started on it to get out of Methadone Clinic Prison (Daily Visits...). I tapered down to 39mg/Methadone/day and was still worried, about waiting long enough. With long acting opioids especially, if you're not in at least moderate withdrawal, Bupe's affinity for Opiate receptors is nearly unmatchable, and will kick the full agonist off, and I have heard precipitated withdrawal horror stories. I went to my Dr. after over 48 hours off Methadone, and told him that I didn't feel great, but not that bad either. He said, "No offense, but I've seen you looking WAY worse. LOL" So I inducted myself at home (it was a Fri. evening) on Sat., or whenever I felt more in withdrawal, with directions to page him if I had problem. No problems really (see below). The Naloxone antagonist is supposedly in their to prevent injection abuse, because even sublingually it's not well bioavailable. But given that Naloxone has a miniscule half life compared to Bupe, AND Bupe might bind even better to Opiate receptors than the Naloxone, I've heard that it is mostly marketing. I had no thoughts of injecting so it was/is irrelevant to me.
When transferring from a long acting strong opiate agonist like Methadone, no amount of Bupe is going to be able to fully replace the full agonist. I felt a little uncomfortable for a few days, than a little "down" for a couple weeks, then was pretty much OK, and FREE. 30 day prescription with refills. For a long term Opiate lover/addict/abuser Bupe is pretty much not abusable, plus if you really want to clean yourself up, Bupe blocks pure agonists GREAT. I stay on 1mg of Suboxone now, ONLY because I know what will happen if I wean off. I'll start "cheating", with probably not a great long term outcome. LOL Even 1mg of Bupe can almost completely block 120mg of Oxycodone for me. I'll just get in a "good mood".
But BEWARE! There is saying that "less is more" with Suboxone. At low dosages it is a very powerful narcotic with agonist properties, but not as nearly as euphoric as the infamous narcotics. I've seen 2mg of Suboxone put an opiate naïve individual into cold sweats and dry heaves all night. Yet I quickly started being maintained on 24mg/day! I truly did forget I took a dose one morning, and took it again a couple hours later. 48mg! I felt NOTHING. Buprenorphine has a "ceiling effect" due to it's agonist/antagonist nature, that they say maxes out at 24mg, but I have a feeling it's a lot lower. IT'S EXPENSIVE TOO. IMHO peope with "minor" Hydrocodone/Vicodan habits are maintained on way too high an initial dose of Suboxone, and Sub, is NOT easy to come off of. I got on that dose chasing what was not obtainable -- to feel as "normal" as I did on the Methadone. You won't. In a couple of weeks, the sub-normal will feel normal again. 16mg or less would have been PLENTY.
When I saw the "less is more" light, meaning the degree of it, I tapered and got down to 1mg in an amazingly short amount of time, but took just long enough so I didn't feel a thing. I have been assured, by friends, and reading on the web, that 0.5mg down to zero is the hard part. How weird is that? People jumping at 0.125mg (don't forget we're talking long term use now), are still in for a lot of hurt. I saw a post, where the person started skipping days at 0.25mg, then moved to 0.125mg 7 days/week, then started skipping days, and eventually he jumped with minimal discomfort. LOL This is FUNNY, but NOT REALLY: In the US, the smallest dose they are making at the moment I believe is still 2mg film strips (vs. the pills). The manufacturer warns that, "The distribution of active ingredient in the film may not be uniform, therefore the film should not be divided. This is utter BS. It would be HARD to make the film in such a way that the ingredients weren't uniformly distributed, PLUS quitting Suboxone after long term maintenance at 2mg/day is probably doomed to failure. Considering that it is rather pricey, and the manufacturer still has a patent, a cynic might think they don't want people to quit!
Suboxone can be a God send to people wanting off narcotics. My advice is to be aware of the ceiling effect, and that it's expensive, and that less than they probably want to maintain you on will probably work just fine. 16mg is called a "target" a lot. That's a lot. 24mg was just flushing money down the toilet. And if/when you finally want to come of Bupe/Suboxone/Subutex, expect to taper to what you used to think were miniscule dosages pretty easily. Then at around 1mg start to expect some discomfort, and take your time, there isn't a race. Once you know what to expect, it makes things (like discomfort) more bearable, than if it springs on you by surprise. Going from 24mg down to 0.25mg, breathing a big sigh of relief and stopping, will definitely give you a surprise. LOL Hard to believe but true.
I hope someone finds some of this of value. I wish I'd read it about 5 years ago.
