Hello Everyone-

I am a chronic pain patient with absolutely debilitating migraines. I have been on hydro for about 6 years at varying doses, right now about 8, 10/325 per day. My doc started me on clonidine .10 mg twice a day last spring as a way to reduce dose and help with pain too (didn't help with dose).

I want to go off Norco all together and go as long as possible without to try to get the tolerance under control (I know it will take awhile). My doc scripted me for Subutex 2 mg. actually to see if it will help with pain, but I want to try to go off Norco if possible.

What is my best route to do this? Can I stay on clonidine and subutex at the same time? I also take several other meds including Wellbutrin, Lamictal, and triptans for the migraines. Can I take all this together? If, God forbid, I get a horrid migraine while on the subutex (or if it triggers one), how long do I have to wait to take a Norco? I'm trying to keep the subutex at only a couple mg.

Please help. I feel so desperate and depressed right now. I just don't know how I am going to make it through this. Please help me.

Oh, I should add- my doc tripled my clonidine dose (although I haven't started the higher dose yet). I am asking some of these questions because he only has a couple patients on subutex and I am not doing the induction in the office.

Once you take the subutex the Norco will not work for a few days as it blocks it from working. You should google it and read up on ot before you start taking it so you have an idea what it does...

Thank you, yes...I have read about it pretty extensively. Nothing I have read has really addressed some of my questions though like taking it at low doses verses the typical 8-16 mg I see a lot of people on. I know it has a half-life of about 36 hours, but I wonder how pertinent that is if a person is only taking a couple mg.?

Also, there is not a lot of info at all about drug interactions on it.

I hope he didn't write that on the prescription! This is how 10mg gets administered by mistake. It's always worth checking. Anyway, the dose for migraines is 50mcg (0.5mg) twice daily, increased to 75mcg if necessary after a couple of weeks. However, the drug is not recommended any more in the UK for migraine prophylaxis.

Choices are beta-blockers, pizotifen, sodium valproate, topiramate, and cyproheptadine. Of course, the US may have other drugs available and have a different view about clonidine and methysergide, but it may be that if clonidine is considered suitable, it is being under-dosed (not a recommendation to increase it without supervision). This is all from a prophylactic point of view; I'm assuming the triptans are for acute attacks?

Yeah, the triptans are only as needed. Unfortunately, I need them about 4 days a week. I have tried all the migraine prophylactics at this point I think. We went over my med history a couple of months ago and I have tried close to 30 medications.

I don't have much to offer in the way of all the other things you take and interactions and such, but I have been on sub and have something to add there.

I have a chronic back issue and choice too, to get off the opiates all together last year. My doc assured me that sub was wonderful for pain issues, but I did not find that to be quite accurate. I did help the pain some, but not near the relief I needed a lot of days. I had to rely on muscle relaxers much more and while they were helpful, they made me lethargic to the point of not being functional.

I was started out on 12 mg and told to stay on that dose. After a couple of months, I started having issues, etc. with the medication and decided to get off of that, too. When tapering, I found that the 2mg dose was just as effective as the 12 mg and I lost a lot of the side effects that I didn't like. If you are able to start on a lower dose, I think that is the best way to go.

I have also had migraines in the past, although, nothing I am sure like you experience. My heart really goes out to you for having to endure that kind of pain day after day! I can't see how sub could help with that kind of intense pain, though, and once you are on sub, narcotics won't work (except some in the hospital I believe). It looks like you have tried it all and then some. I hope you get the relief you are looking for and the help you need! Best wishes!

Yes, and this is exactly what the doctors and/or the manufacturer of this medicine doesn't want people to know. It also seems suspicious to me that they have not allowed the 0.4mg unit doses into the US. It could lose them a lot of money if they did, and the rest of the world seems to have them.

Thank you guys for all the information. I am going to start out with a really low dose. I still can find very little about drug interactions. Do you think I should stay on my other daily meds? if I get a migraine, do you think taking the triptans is okay?

I can only find info. on not taking anything too sedating and also problems that have occurred when people injected it with xanax. There is not a lot on other potential interactions.

It can be treated in the same way as other opioids, so the standard interactions apply as they would with morphine, oxycodone and so on. The only interactions I can find that are specific to buprenorphine are with ketoconazole and ritonavir.

Thank you, Nephro. That is about the only interaction warning I can find too. That and anything sedating, but again- I'm sure the danger depends largely on your dose.

Another question- How long after your last opiate dose do you really have to wait to start the sub? I have seen a lot of references to 12-24 hours (usually the high end of that), but the prescribing information says only 4 hours after a short acting opiate.

I wonder how long I really have to wait? I feel like I start getting WD symptoms much sooner than 12 hours. Would starting sub in the morning when I would normally take my first Norco work? That would be about 8-9 hours.

When signs of withdrawal appear is probably the best time; in patients who have not undergone withdrawal, my source says to wait at least 6 hours (regarding heroin use). I the case of methadone, however, 24 hours is quoted.

Okay, I will try to push it as far as I can. I start developing the body aches/bone aches very soon after a dose of Norco, like within 3-4 hours normally. The other WD symptoms don't start until like a day without a dose. I am just not sure what constitutes enough WD to start the sub.

With every other drug you are rx'ed, the purpose is to take the least effective dose. Treat Sub the exact same way. I read more posts regarding the dosage of Sub than anything else about the drug!
I have to throw this out there though: Most patients on Sub are accustomed to taking "more than prescribed" of their DOC, and aften "assume" that taking more Sub will induce the same euphoric effects that other opiates do. However, that is simply not the case. As a matter of fact, the lower the dose of Sub, the more positive the experience and as Bryansfan put it, the less likely to suffer undesired effects.

You know, my sub Dr. was actually "angry" at me for saying I was experiencing bad side effects and wanted to lower the dose. He got very aggitated and told me that there were no bad side effects that ever occured due to the sub and maybe I should see another Dr. for my "severe" problems. After he made me feel about 2 inches tall, I handed him my research about other people suffering ill effects at high doses and he tore it up and said it was "nonsense". At any rate, I asked him for enough to taper and get off the drug, so he have me 30 days worth and sent me on my way.

As a Dr., I thought his main goal was to make me better, but I actually felt like it was completely money driven. I think he would have kept me on Sub for life, if I let it, so he could keep getting his monthly visits. It was a rude awakening and I will no longer feel the same trust I felt when I walked in to his office that first day, for any Dr.

Your doctor might have done you a backhanded favor by being an a-hole regarding your dosage. Maybe your frustration with him was helpful to you during your taper off of Suboxone?
Whatever the case, you, "melpat" and others are wonderful examples for the participants on this discussion board who have convinced themselves that harm reduction treatment options like Suboxone and methadone sentence them to a life-long attachment to these drugs.
Thank you for sharing your experience and congratulations on your recovery.

I agree. I can't thank you enough for sharing your experience. The more I read, the more I am convinced that a low dose fast taper off the Subutex is the best way for me to go. My whole point of doing this is to get off the Norco as long as possible to reduce my tolerance. Luckily, my doctor is great and I am doing this on my own accord, not being forced to directly or indirectly. My doctor just does not have much experience with Subutex yet, so it is making things a little more difficult.

I think the higher doses are meant for diamorphine addicts who may use large amounts of diamorphine to overcome the block, and the theory is that they will fail.

People who just really want and are committed to getting off a mild to moderate pain med habit, and the lower doses of buprenorphine should suffice. Especially when the pain meds were prescribed for pain.

That is exactly how I see it as well. I was determined to get off sub w/ what he gave me so that I never had to go see him again! Anger is sometimes a wonderful motivator!!! I am thankful now for my experience and actually glad that I had so many issues because it makes me more determined than ever not to go through that type of H E double hockey sticks again.

Now, if I could just find a reasonable solution to the pain, I would be all set!!! LOL, me and thousands of others, right? One can always dream!

The support I got here, as well as all the advice, was wonderful and I can't thank those people enough who have had my back!

My advice is to stay as low as you can and get off as quickly as is doable for what you need, with your docs assistance of course. I sure hope this will help you with the migraines!!!!

One of the things I keep replaying in my mind is how well the Norco worked for the migraines at first. It never completely kicked them, but with the other meds they at least reduced them to where I could function.

As we all know, with opiates, tolerance and dependence builds so fast. If i can do anything to reduce the tolerance even some, I will be happy. I just don't want to have to keep increasing the Norco dose.

If your real purpose in starting treatment with buprenorphine is to lower your tolerance to hydrocodone, I think you are wasting your time and money.
Both are narcotic opiates and the Subutex is much, much stronger mg. to mg.
If anything, you may find that when you return to Norco use, you will require even larger doses of it after you have been taking Subutex for a while.
One of the almost unavoidable long-term realities of opiate medications involves tolerance. From my experience, it is very difficult to reduce it effectively even by discontinuing the drug for periods of time.
If this is an idea that your physician has concurred with, I think you are correct that he doesn't really know what he is doing with Subutex.

Hi friends,
Welcome GardnerGirl. I've been on Sub for 4 months now at 16mg for a hydro habit of 180-200mg of hydro a day, 18-20 Norco/day for 2 years +. I am really, really fatigued and sleepy on this dose. I'm seeing my doc tomorrow and would like to taper, but not too fast to get my body used to the change, down to 8mg for a couple of weeks, then 4mg, then 2mg then 1mg...if I can do it....I'm very scared about going off but if I taper slowly, that would still be a couple of months away. My doc, who I really like, said he usually talks about tapering after 6 months but I'm ready.
Also, he is way into making me comfortable with other meds if the w/d from the sub is bad.
I kind of agree with martind about sub maybe not being the right drug for you. It does increase your opiate tolerance and even after you are off it, your tolerance is still higher and may always be...just check into that more with your doc.
Another suggestion, I was told to be in mild to moderate w/d's before I went in for my sub induction. I went 22 hrs and was just beginning to feel the sweats and aches so it wasn't bad. The sub worked right away and was a tremendous relief. Those first few weeks, it felt like it was truly a miracle drug. Now, I'm not trying to say it isn't helpful because it is and if I had tried to get off any sooner, I'd have been jonesing and out on the streets looking for more hydro. But, now I think my dose is too high so I want to lower it fairly slowly. It is true that 2mg works as well, if not better than 16mg. I really do believe that. Maybe at first I needed a higher dose because I had used for so long but now, 4 months later, it seems that I can come down significantly.
Please keep us posted and let us know what you decide to do!

Take care,
Woodrow

You sound like another patient that should have been put on something like 4mg at the beginning, since you weren't seemingly at risk of trying to overcome the blockade with huge amounts of hydrocodone. Surely you could have taken the first 2mg dose and see if it attenuated your withdrawal, and if not, titrate upwards.

Yeah, I am planning on doing just what nephro is saying. I am planning on starting over the weekend. I am going to start with like 1 mg and go up to only the minimum I need to keep the WD at bay. I am also only planning at this point to be on it for a couple of weeks or less.

Possibly I am not understanding why you are starting the use of buprenorphine.
What do you and your doctor see as the purpose of taking relatively small Subutex doses for two weeks or less?
I'm confused about what your goal is.

your dr. would lower your dose slowly monthly to wean you off of sub but would never temporarily lower your dose just to eventually increase it again. thats just called getting high when you lower your dose on sub then increase it. it defeats the entire purpose of taking sub to begin with. perhaps you should seek out a new sub dr. good luck!

Yes, I was speaking in retrospect - it had to be done in the beginning, as is done with methadone. I don't think her doctor is in on this one, but there's nothing to stop her tapering more rapidly downwards.

LOL, my doctor is absolutely in on everything I am doing. There is not just one way to take suboxone/subutex. A lot of people on this board seem to be on relatively high doses taken over long periods of time. That is not the only way to take it. It is used for short term detox, mtnj. Some places that I have read about online put you on it and begin to taper as soon as five days after starting it.

My doctor and I have talked about using the subutex as an adjunct to the clonidine to help me get off the Norco for as long as possible to reduce the tolerance. Getting off the Norco like this has helped before. I just have to hope and pray that I go long enough without a crippling migraine to make a difference. I have no way of predicting how it will go. Sometimes, I go a couple of weeks without a really severe one and sometimes I get 3-4 in one week. This is one of the factors that has made reducing the Norco difficult.

The other reason my doctor was willing to let me try subutex is because there are a couple of studies out about it being used for chronic pain. Again, this is one of the reasons why we are trying it. If while on it for a few weeks, it seems to help with the pain as well- we may continue it longer term to REPLACE the Norco.

This is how we have tried numerous drugs in my course of treatment. Some have helped. Some haven't. My treatment goal is to be on as little meds as possible, not to be on 16 mg of something like Subutex for months on end. My entire motivation for taking subutex is to help reduce my tolerance (which it might do if taken for a few weeks, not several months) or to possibly use it for chronic pain if it works well. I am not using it to kick an illicit drug habit. I am not "getting high". I am taking these meds for a debilitating medical issue.

Sorry, I was confusing you with 1woodrow, who started at 16mg. For pain management, 0.2mg - 0.4mg are effective doses.

LOL, it's okay...no worries...

The whole situation is just so emotional and frustrating. I am absolutely scared to death that I am going to get a migraine while on the subutex. That is my biggest motivation for getting off of it FAST. Of course, if my pain is better on it, the worry might be for nothing.

This is something that I am doing on my own accord. If my doctor had his way, I would be on Oxycontin tomorrow. It is ME that doesn't want to do that. I don't want to go higher in my pain killer dose if at all possible because of all the side effects, like horrible fatigue. Reducing my dose is something I want to do for myself. My doctor is not asking me to do it.

I am even thinking about consulting with a plastic surgeon about getting a facelift (and I am only in my 30's) because there was a story on the news about that helping migraine sufferers. That is how desperate this situation is to me.