Street fentanyl > sub

Will methadone and buprenorphine together cause withdrawal? How do I stop precipitated withdrawal? What dose of buprenorphine is best? Do I have to be in withdrawal to start Suboxone?
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Longgone
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Street fentanyl > sub

Post by Longgone » Thu Jun 25, 2020 4:13 pm

Here I go again and I am quite scared this time to go from using a lot of 30 mg fentanyl pills (I always snort them), I am using about 15-20 a day.

How do a make CERTAIN I do not go into precipitated WD’s....I will use the COWs sheet but have heard the street fentanyl is very tricky to know when to take the sub.

Any help really appreciated, I need to do this right.

Thanks

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jennjenn
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Re: Street fentanyl > sub

Post by jennjenn » Sat Jun 27, 2020 8:32 am

Hey Longgone!

As you know fentanyl is so dangerous. The fentanyl pills around my area has ppl overdosing daily and some make a recovery and some do not, sadly. I hope you can make this transition to suboxone for the final time this time so you don’t have to ever go bk to that life again.

Induction onto buprenorphine coming off from fentanyl can be difficult as I’m sure you know this. You seem to be on a pretty steep dose right now too. Gosh this is really a question best suited for suboxdoc or docm2. As you know, you need to be in withdrawal to start your suboxone and with fentanyl you are going to need to wait a bit longer than you would wait on shorter acting opiates. This is kind of unorthodox but if it were me, I would probably switch to shorter acting opiates for a short amount of time while waiting for your tolerance to come down a little bit. What else can you do though? I mean really, what can we do? Unfortunately it’s a drug that is very strong and it will stay in your system a lot longer than the others. Precipitated withdrawal may happen but if it does just keep dosing your suboxone as prescribed. If you aren’t going to a doctor (which if you aren’t you definitely need to especially with an induction like this) then take a specific dose each day and I promise you that you will start feeling better soon. If you experience pw then it is only temporary, try to remember this will pass.

I sure wish I could give you some better advice, I’m sure others will be along and hopefully one or both of the doctors will stop in. I wish you nothing but complete success and an easy transition. Please keep us updated and good luck!!
Jennifer

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Re: Street fentanyl > sub

Post by docm2 » Mon Jun 29, 2020 9:22 am

I'm confused as to what you are taking. Fentanyl is not taken orally, there are buccal tabs but they are in micrograms.
If your tolerance is as high as you profess many will advocate starting with methadone. You avoid the PW that way, stabilize and then later can taper, continue on methadone or taper and transition to buprenorphine.
Even if you get started on Suboxone the cravings will be quite high for a couple of weeks due to the mismatch of affinity and activation of receptors.
Jenn's idea is a good one but I doubt if you could find enough short acting opiate to cover your tolerance, around here a lot of it is laced with fentanyl, especially the heroin.
Your doctor cannot prescribe anything as that would be illegal to treat withdrawal with an opiate.
An option is to go inpatient, they can monitor, give comfort meds for 3-4 days then start Suboxone.
No matter what you choose it will be difficult.
good luck

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