Im sure everyone is aware of the fact that buprenorphine will fully or partially block the effects of heroin (or other opioids) for a day or two (perhaps a bit more, perhaps a bit less).

Its also well known that OD's can often occur when someone is trying to "fight through" the buprenorphine with a higher dose of heroin. For instance, someone's normal dose of dope might be 1 bag (approx. 100mg). If however, they took suboxone in the morning, and then wanted to use dope that evening, they might find that 1 bag has no effect due to the blocking action of the sub, and so they might try a 2nd and 3rd, and then all of the sudden they have OD'd.

What I am curious about is if buprenorphine always will have a blocking effect, and never have an additive effect. For example, if someone took 120mg of oxycodone, and then a few hours later took some dope, they would have to be very careful about their dose of dope since the oxycodone would still be active and would have an additive effect when combined with the dope. In this case they would have to take a smaller dose of dope then they normally would.

My question is, is it possible that what I described above would ever be the case when combining suboxone/subutex with dope? After all, buprenorphine IS an opioid, so are there any conditions under which bupe would actually have an ADDITIVE effect when combined with heroin, thus requiring one to actually lower their dose of dope, or will bupe always partially block the effects of other opioids, thus requiring one to increase their usual dose of dope in order to achieve their usual "high"?

I hope Im making myself clear. I guess my question could be simplified by asking this:

If someone has taken bupe earilier in the day, or perhaps the day before, do they ever have to worry that their usual dose of dope will actually be dangerous due to an additive effect with the bupe?
Thanks-DG
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I think the answer lies in which opiate effects are blocked by suboxone. Its kind of like the "how will they treat pain while on suboxone" question. There will be a number of variables: dose, how long on suboxone, etc., not to mention the range of physiological variables of the person in question.

My experience has been that after years of ORT, the blocking effect lasts a *long* time. A rapid switch to a morphine pump produced little analgesia for 3-4 days. with no euphoria. Of course, despite what doctors may say about treating an addict's pain ("we'll take care of you"), my theory is that they will ALWAYS underdose you.
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i was under the impression that the naloxon (sp?) is what keeps any other opiate from gaining access to the opiate receptors. so the naloxon acts as an agent to blocks too much buprenephrine or any other opiates from opiate recptor access
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i heard from a fairly knowledgable source that said combination is potentially lethal... :-) im not 100% certain on this but i sure as shit wouldn't try it. i use suboxen to scare myself from doin dope... not to potentiate???????!!!!!!??
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No the naloxone is in there to prevent addicts from injecting the pills which would lead to a perticipated withdrawal. At least that's the theroy.
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Yeah, but the binding affinity of buperenorphine is much greater than that of nalaxone, so the nalaxone in suboxone pills is virtually a waste, and does next to nothing. The bupe is what will cause you to go into precipitated withdrawals if you dose it too soon after other opiates.
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If it is an partial agonist-antagonist surely if not all your receptors are saturated it would produce an accumulative effect at very low doses? Is the affinity also preventing the full agonist from binding (similar to methadone)?
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Yes, something like this is what Im wondering about. My thinking is that while bupe does block opioids with lesser affinities, if your dose of bupe is low enough that not all receptors are being occupied, then is it possible that by taking your normal dose of heroin, you will actually have an INCREASE in effects due to a cummulative effect between the bupe which is occupying and activating some recpetors, and the heroin which is fully activating the unoccupied receptors.

Im wondering if this should be moved to ADD because as I feared (and no offense) but most of these responses have digressed into the ppl stating the common misconception that the naloxone is what causes the blocking effect.

Just to try to dispel this myth once and for all-the naloxone in suboxone has no real effect or purpose. Bupe has such a high affinity for opiate receptors that the naloxone has no chance of binding to your receptors when the bupe molecules are present.

So again, my question concerns whether or not one's "standard dose" of dope (or oxy or whatever) might actually be dangerous due to a possible cummulative effect of bupe that was taken earlier in the day.

We always talk about how bupe blocks or diminishes the effects of other opioids and thus a user must use more dope to achieve the high they are looking for. But what Im wondering is if there are any situations (perhaps dose related) where one's standard dose of dope will actually create a MORE potent effect due to a potential additive effect of bupe take earlier in the day or the day before. thanks-DG
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yes, they do put the naloxone in the suboxone thinking its going to block the effects and the user wont get high. But i have taken both suboxone and subutex for long periods of time. First suboxone and then subutex. What many people don't know is that the reason that they even perscribe these meds for opiate addiction is because buprenorphine has a cieling effect of around 28mg-32mg. so after you reach that peak, you can take as much as you want you wont get any higher. Subutex works the same as suboxone, actually better IMO. you dont have all that bullshit naloxone in there that everyone is allergic to, they just don't see the acute symptoms as being from the naloxone, and think its from the opiate wds.

anyways, to answer the OP's question. I'm pretty sure that bupe will always react the same way with other opiates. The reason that most doctors perscribe suboxone instead of subutex is because they think that with suboxone you can't abuse other opiates bc of naloxone, and with subutex you can use other drugs. Which is just retarded, but theyre not dopeheads, so how would they know? It took me so long to find a doc that would perscribe subutex. Yes you can use other opiates while on bupe, but as you've already found out, they won't be nearly as strong. I've done suboxone, heroin, and then suboxone again all within the same day. In my experience i didn't go into withdrawls or have any problems besides not being able to get to the point of satisfaction. It seems that when i took the suboxone and then the heroin i didnt get that high, but after i took the second dose of sub after the last dose of heroin, it seemed to be a bit stronger, but not much. I think the reason for this is because sub has a higher affinity than H. so when i took the first dose of sub it had already binded to my receptors and once i took the H it really wasnt a match for the sub.

Honestly, i wouldn't even waste your time with that. Just either do one or the other, because you're just going to get pissed off and end up wasting a lot of money lol.
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I kind of answered this in another thread.

Whether buprenorphine will synergize other opiates, or will block their effects, is dose-related. If you take a small dose of buprenorphine and then other opiates, synergy is more likely whereas a high dose of buprenorphine then other opiates leads to the buprenorphine blocking the other opiates.

What a "high" and "low" dose depends on individual factors.

The theory is wrong though, you can get high from IV subutex/suboxone just as you would with any other ROA.
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Would you mind posting a link to that thread in which you discuss the possibility of synergy between bupe and other opioids?

But at least from your short response here, it sounds like you are saying that bupe CAN actually have an additive effect when combined with other opioids. Thanks-DG
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I believe 8mgs of bupe blocks something like 30-40 % of the receptor, while 16mgs has an almost full blockade effect.

The main thing to worry about with bupe+opiates is respiratory depression. I fucking hate having to deal with the stress of bupe in my system when I want to dose opiates. Usually ends up being a big waste.

If you're on bupe, you probally shouldn't be doing opiates. But we know we all have. *shrugs*

-lenses
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There can definitely be a cummulative effect IME when combining Buprenorphine with a full agonist Opioid. Though as others have mentioned, I too believe it is more or less entirely dose- dependant. If you are on a high dose of Bupe, and take your usual dose of DOC, it is likely you will either feel next to nothing, or you will experience effects far milder than you would without the Bupe. However, if you are on a low dose of Bupe(the lower, the better), and you take your usual dose of DOC, you will receive most, if not all, of the effects lent by your DOC, in addition to the effects brought on by the Buprenorphine.

Example: One day I took roughly 0.25mg Bupe to help myself feel better. Later that day, I took some Lortabs, worried about the "blockade effect" interfering with my buzz, only to discover that I felt the same buzz as always from the Hydro, in addition to the "wellness" I already had going from the small dose of Bupe. It was clear to me I was experiencing a more pronounced effect from combining the two than I would have with the Hydrocodone alone. I found the same to be true with other Opioids like Morphine, Heroin, and especially, for whatever reason, Methadone.
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The reason they prescribe buprenorphine for opiate addiction is because R&B bought ("gained", "sought out") approval for their versions of buprenorphine.

The ceiling effect has little to do with this. Other opiates have ceiling effects, such as codeine.

Originally Posted by :
Which is just retarded, but theyre not dopeheads, so how would they know? It took me so long to find a doc that would perscribe subutex. Yes you can use other opiates while on bupe, but as you've already found out, they won't be nearly as strong. I've done suboxone, heroin, and then suboxone again all within the same day. In my experience i didn't go into withdrawls or have any problems besides not being able to get to the point of satisfaction. It seems that when i took the suboxone and then the heroin i didnt get that high, but after i took the second dose of sub after the last dose of heroin, it seemed to be a bit stronger, but not much. I think the reason for this is because sub has a higher affinity than H. so when i took the first dose of sub it had already binded to my receptors and once i took the H it really wasnt a match for the sub.

I used to be able to wake up and take Suboxone, then still use heroin at night. I haven't used heroin for over a year now.

I like what you said though - the doctors definitely don't know since the majority of them aren't dope heads.
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There's probably a more relevant thread for this, but the collective pissing that's done on naloxone viz a viz buprenorphine is slowly being questioned by researchers.

To put it more directly, what, as a paramedic, would you do if responding to a situation in which a person is OD-ing on bupe? (most likely this will present as acute respiratory depression and consequent hypoxia)

Cuz theoretically, naloxone can't reverse the efects of bupe.

This is a link to a group of studies that have found the theory to be partially wrong. The first one is the most recent one I know of and the researcher reaches a pretty cool conclusion about the special functions of mu receptor subtypes.

But will someone that knows bupe inside out please fix that crazy bupe article on Wikipedia? It reads like an ass with four monkeys.
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It sure can but I'll go ahead and link you. I think I could have merged it into the Suboxone mega thread. http://www.bluelight.ru/vb/showpost....&postcount=582

there you go

That's whats up.

I could definitely use opiates as well after the 0.25mg that I normally use (I normally use buprenorphine 3-5 times per day), but I don't like using other opiates anymore. I've been clean from heroin for a whole year now and I'm pretty glad I stopped using it.

Wikipedia does not need to know the truth.

If you need to know the truth, it is out there.

What about the wiki article is incorrect? I haven't read it recently. People might've changed it for the worse.

Plus, doom metal is awesome. Electric Wizard are pretty good.
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Son of Nothing is my favorite song.

I don't think too many people want to read it. It's gotten bigger instead of better, and everyone's pennies seem to be in there. It doesn't refute the original naloxone fuckup very well (probably because R&B edits it a lot) and it's full of a lot of bullshit or outdated claims like bupe being significantly more expensive than methadone and methadone being easier to find on the street than bupe. It hangs on to the naive notion that bupe is only prescribed by docs with Data2000 permissions. It gets into tangential material about NA and such. It just taps the subject of bupe's antidepressant value, and why is the BUPRENORPHINE VS METHADONE section like 10 times as long as the pharmacology/pharmacokinetics section? I could go on.

It's an enormous article with ridiculously few citations. Trip reports on BL are more accurate in many places. It doesn't look anything like the well-organized pharma articles. It barely discusses synthesis. etc.

I know what u mean about wiki not needing to know the truth. It's the best crit I've heard of wiki in a long time. Problem is that for lots of people, wiki is the truth.
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Yeah it seems that there is a cumulative effect only in small doses. In high enough doses bupe seems to become less of an agonist and more of an antagonist. In that case it is sort of just sitting at the opiate receptor and not activating it.

Taking a high enough dose of heroin might start to knock some of the bupe off the receptors but it seems like it wouldn't have much of a cumulative effect in that case. This is sort of a tricky question to answer with any certainty IMO. There seems to be a lot of variables involved.
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Thanks for the responses guy. Basically, Im just concerned because I tend to bounce back and forth between bupe and full agonists, several times a week.

When I take bupe (like you Captain.Heroin), I will take about 4 doses a day, eahc of about .50mg. I find I get a better effect doing this, then by taking one large dose a day.

So what concerns me is that sometimes Ill take one small dose in the morning of bupe, and then take a full agonist later that day or night. While I know that bupe tends to have a blocking effect, Im always concerned that my "normal dose" of the full agonist might somehow synergize with the bupe, as opposed to being blocked by it, and I might find myself in trouble.

I was obviously hoping to hear that in all cases, bupe will either decrease the effects of another full agonist, or at the most, have no net effect on it. But it sounds like at small doses, one might actually have to LOWER their dose of the full agonist if they have taken a small dose of bupe earlier in the day. Thanks0DG
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Stick with it, I know its hard, but for me, it gets easier every day. I was on a 3-80's a day oxy habit about a year or a year and a half ago (which is quite i bit for me considering i'm about 107lbs) Finally ran out of money, and H is pretty fucking scarce around here. Usually only around tour season is when its around. Found a doc that would perscribe suboxone in Oct-08. After months of use i really started to feel like shit. I would taper a lot, but I became super depressed and had the worst anxiety, which is the complete opposite of my personality. I was just so worn out and tired all the time. My boyfriend finally talked our doc into switching us to subutex around the March of 09, but then the bastard tried to accuse us of selling the shit, and "doctor shopping", and dropped us after the first script he gave us. His allegations were completely untrue but we were forced to relapse and couldn't find a doc for so long. We were going to try and sue him, but who's going to believe a junkie over a doctor of 30 years. After going through a lot of bullshit with many different doctors, and wasting thousands of dollards, finally found a great doc that would perscribe subutex. So I've been clean for about 5 months now since my last relapse. Would have been a year. I don't ever crave that shit anymore. It feels so good when you finally get your mind back, ya know? Don't know if you're still on bupe but I would definitely recommend anyone on suboxone to try and get switched to subutex cause it really does make the world of difference. Feels so much cleaner, i really think it should be perscribed as an alternative anti-depressant. The only thing that sucks is they're more expensive. Doesn;t really make since, less ingedients. But congrats man, stick with it! :-)
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Because the pharmacology and pharmacokinetics of buprenorphine are largely under-investigated and under-researched.

The bupe V methadone section is so long because people switching from one to the other (and vice versa) need to know why which switch is easier than the other one (bupe -> methadone is a lot easier than methadone -> bupe).

Originally Posted by :
It's an enormous article with ridiculously few citations. Trip reports on BL are more accurate in many places. It doesn't look anything like the well-organized pharma articles. It barely discusses synthesis. etc.

Well, you are right. There is a lot of incorrect info on there. As for correcting it, I've never edited a wiki article and I don't have an account through wiki.

I would change it but I am about to head out of here (busy all day today).

Originally Posted by :
Problem is that for lots of people, wiki is the truth.

I think it's sad not everyone will get to know the truth, but I think it's better that way. People live happier in ignorance than they do in reality.
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Trauma
Im a bit confused about some of the things you are saying. You seem to be making a massive distinction between suboxone and subutex. Unless I am misreading your post it sounds like you are stating that suboxone is an awful medication which made you depressed, but subutex has been a miracle.

Now Im not saying that what you are claiming is impossible, but from a pharmokinetic standpoint, I must say that it doesnt really make any sense. Subutex is is just buprenorphine, suboxone is buperenorphine with a small dose of naloxone added to it.
It has been said over and over and over that the naloxone in suboxone has no effect. If you are unfamiliar with the reason for this, essentially, bupe has an extremely strong affinity for your opiate receptors (MUCH stronger the naloxone's affinity), so when you take bupe and naloxone at the same time, the bupe binds to your receptors, and blocks naloxone from being able to do so. So while the naloxone is present in your bloodstream, it does not attach to your receptors, and thus, cannot exert an effect.

So, it seems strange to me that you have noticed such a massive difference between bupe subutex and suboxone. -DG
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Ive had this happen before, small dose of suboxone and some heroin and it actually increased the effect it seemed like. I cant remember what I did first though Im pretty sure I did like .5 mg of sub then like 6-8 hours later did a bag and got higher then normal
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I really don't think that suboxone is an "awful" medication, i just feel that subutex is better. Maybe just for some, but for me it really has made so so much of a difference. Maybe it could just be my mindset on the two? I'm not really sure why, but i have had my experience with both for months at a time. While i was on suboxone i HAD to get switched to subutex. Not necessarly because of the depression and anxiety, that's something i can deal with on my own, and try to make better myself. But, i was having crazy heart problems. I would randomly have spells where everything would just slow down and my heart would start racing, i'd get extremely dizzy to the point of almost faint, and would have to lie down for a while until it subsided. Kinda similar to a panic attack...without the panic. I couldn't even smoke cigarettes. I don't really know why this is, because as you said, they are pretty much the same thing. Initally i did think that it was due to the naloxone, somehow. Because when i made the switch, all of that shit went away. If the naloxone doesn't really even have a chance to bind to receptors, then i just don't see why i was having these problems with suboxone and not subutex. As you said, Just doesn't make sense. I'm not saying what you're saying is false, i honestly can't realy see why it has made such a difference either, if all of the naloxone theories are true. My question is, if it doesn't have a chance to bind to your receptors, then where does it go? I wouldn't think that it would just vanish. I know you said that it goes to the bloodstream, but is it impossible for it to have ANY effect whatsoever? or does it just not work, period. Because as i've said, IME it really is so much different for me. Honestly, viewing it from a scientific standpoint, it really boggles me too.
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