I really do hope this will work for you and I am sorry that I don't have much to contribute in the way you want to use sub. I think that most, if not all, on this board who have used sub were using it to totally get off of any narcotics and stay off, so our opionons or thoughts are based from that train of thought. Also, most of us that have been on sub. have started at higher doses and then tapered.

My only caution to you is that if you do get a migraine while on Sub, you will most likely have to go to the ER for treatment, as your normal hydro will not work at all with sub. in your system. I have had migraines and I can't imagine what you have to go through in your quest! I know you are working with your doctor and it is a trial and error w/ most meds! My best wishes, though and I hope you find relief!

It sounds like you have made up your mind regardless but in all likelihood you are going to end up with a much higher tolerance to opiates after your experimentation with Subutex. Your doctor should be aware of that if he has any history prescribing it.
Buprenorphine might very well help with chronic pain treatment, although I've never heard of it being used to treat migraines.
Please be aware that the doses effective for chronic pain are typically well below 2mg/ day. Buprenex injectable formulation has been used for a while for that.
Hopefully you find low dose buprenorphine helpful for your pain because going back to Norco is not going to accomplish your goal of reducing tolerance in any way.

Thank you, guys. I think your comments are very valid. Those are some of my very concerns. My doctor had mentioned that if I did get a migraine, I might end up having to go to the ER. I have read a few people that have had increased tolerance after taking the sub, but in every case I read the person was on a high dose over a long period of time. I am not say you are wrong, martind, I just hope that a very short trial of the drug does not increase my tolerance. Obviously, I am hoping for the opposite.

If it does, God forbid, then I am back at looking at going on a med stronger than Norco (which is what my doctor has mentioned anyway).

You know- I am definitely taking all of your opinions into consideration. I think so much of what you are saying makes sense. I know this might not be the best option for me. I still think I will end up trying it, but I might first give the clonidine a shot again (especially with the increased dosage). If that doesn't work, I may try the subutex, but at even a lower dose than I had planned on (like even .25-.50 mg to start). I only filled a partial script, so it is not like I am going to be out a lot if I don't take it.

Tolerance increases quickly over a few weeks. You can check an equipotency chart to see how much impact you're getting.

If you want to prevent tolerance from soaring, the only practical way is to take a NMDA antagonist such as dextromethorphan. A tiny dose will halt/and or decrease tolerance depending on how long you use it. About a month should get your tolerance down somewhat but you need to take it with every dose of painkiller. It also blocks some of the pleasant feelings(which explains why it's not so popular) but if you're primary interested in pain relief, that should not be a problem to you.

Can I just jump in and say something, although I don't have the experience that all the other posters here have.

I've had chronic pain for around 15 years. I took subutex for 2 weeks; starting with 8 mg on day one, on day two I took 8, on days 3-7 I took about 4-5 mg. From there I tapered completely off of it within 2 weeks. I then went for about a year or so before the pain became too bad and I had to go to my PCP for help. By then, I had absolutely no tolerance to any medicines. Just one Norco made me feel stupid, silly and unwilling to talk on the phone with family in case I sounded like an idiot.

I think it always depends on what you're after. I wanted to get rid of the pain medicine all together and try just to be okay with nothing. In the end I failed, but only because I have a true, documented pain problem and my body failed me. But the subutex did a perfect job of getting rid of the hydrocodone I was taking at the time. And I stayed that way until the pain drove me back a year later and I ended up on narcotics again.

So using it for a couple of weeks, in my case, didn't raise my tolerance for life. Could it in others? Sure, maybe, I don't know. I'm just telling you my honest story. This happened to me years before Subutex became so popular and I had never even seen it mentioned here when I took it. But it stopped withdrawals in its tracks and I worked hard to stay away from the doctor so I wouldn't be put back on narcotics. It was a husband threatening divorce if I didn't do something for the pain(because I kept him awake all night every night; the pain was too bad for me to sleep so I tore the bed to shreds at night).

But then, I've also been put on Methadone while at a pain clinic, and it never turned into a case of needing more than the 30mgs a day I took, even after months of being on it.

I'll never be out of pain. My condition is inoperable, and I have to accept that and accept that taking medicine isn't the evil thing that my family (not husband and kids but extended family) thought it was. Tolerance will go up with time, but usually the doctors' will change the medicine around so that you don't find yourself on 320mgs of oxycontin a day or something like that. Something as simple as changing to another pain medicine can work. And if you're a chronic pain patient, your first concern should be to get on an extended release medicine to stop all the ups and downs, with breakthrough medicine for when you do something your body doesn't appreciate.

Only you know what you can and can't do, and what you are trying to achieve with the subutex. It worked in my case and it'll work in yours if that is your goal. But..., you can't stay on it for any length of time, not even a month, or you may find you have a bigger monkey on your back than something as lightweight as hydrocodone. You can taper with hydrocodone and if done right, do it with little to no discomfort with a blood pressure patch and small doses of an anti-anxiety medicine like Ativan.

Good Luck and I truly hope you achieve what you need to so that your tolerance doesn't skyrocket. I also know what that feels like, after having doctors put me on heavy duty meds for a couple of years. It turns you into a nonfunctioning person. Always go for the smallest amount that will help you control the pain or control the withdrawal.

That's a good example of why buprenorphine is such an interesting drug. It's a partial antagonist so tolerance is somewhat reduced. Buprenorphine is also reasonable easy to get off from, easier than normal opiates such as hydrocodone.

In my experience, the sub was MUCH harder to get off of than the hydro would have been (or had been in the past). Of course, I was on for a longer period of time, but the PAWS were horrific and very long lasting w/ Sub. I have said before that I thought sub was going to be a miracle and end my use of narcotics easily (I am a chronic pain patient and like Lynn wanted to see if I could live my life without the meds, which is harder and harder each day due to pain issues), but, that was not the case. I know everyone is different and sub sure has done wonders for some, but it needs to be used with more caution than what most doctors are giving it. JMHO!

While that might have been your personal experience with this drug, it definitely is not true across the board.
I can't count the number of people I've worked with who now say that they should have just tapered or detoxed from their drug of choice initially rather than switching to Suboxone or Subutex.
Did you find it reasonable easy to get off from buprenorphine compared to hydrocodone or did you read that on a "suboxone" web site?

My personal experience is irrelevant. I present merely my opinion.

The reason it's often easier to get off from is because it's a mixed agonist/antagonist and thus less likely to produce tolerance and dose escalation as opposed to normal opiates. There is also a ceiling to it's effect.

With a true opiate you get a linear increase in tolerance and withdrawal symptoms and there is no upper limit. In abusers, this may eventually lead to very large doses that will inevitiably produce a very hefty withdrawal. Buprenorphine doesn't produce such a linear increase.

When you switch from a 'real' opiate you frequently have to reduce the dose or abstain for several days, otherwise the buprenorphine will not cover WDs and will actually induce them. This is because of the ceiling effect.

Another thing is that most normal opiates such as hydrocodone have short halflifes which greatly complicates tapering due to fluctuating blood levels. Buprenorphine is more smooth and more suitable for a tapering schedule.

Finally, buprenorphine prevent relapse during the tapering since it will block other opiates, thereby preventing relapse during the tapering phase. Many addicts relapse during this phase. Using a normal opiate cannot prevent that.

If you meant quitting 'cold turkey' only, then no, buprenorphine is not the best opiate to get off from but still better than methadone. People often switch from methadone to buprenorphine in order to be able to quit CT. But an opiate with a short halflife would generally be better. It's probably one of the reasons for using DHC instead of methadone in some parts of the world.

As you say, we are all just writing our opinions but experience and substantial personal observations can be very helpful with forming those opinions. This is obviously one of the primary reasons that the best drug counselors are recovering addicts.
A couple of points you've raised bear further discussion.
The fact that Subutex is a mixed agonist/antagonist does not necessarily contribute to its benefits regarding tolerance and dose escalation. It is a very powerful binding agent and has a long half-life. Thus, the main reasons why its withdrawal, whether tapered or abrupt, is very difficult compared to hydrocodone.
Also, the need to abstain from opiate use prior to starting Subutex has nothing to do with the ceiling effect. Rather, it's because of the antagonist properties of the drug.
And, finally, I think you disprove your initial advice when you point out that DHC is much easier to taper from than buprenorphine when discontinuing methadone. If Subutex withdrawal is easier than typical opiates, why not just taper the Subutex?
There are many actual human beings who participate on this discussion board who have personally experienced withdrawal from opiates and Suboxone. I think that their "opinions" should be examined, read and discussed appropriately compared to someone who possibly has only read data on the Internet.

Actually, your personal experience is the ONLY thing that is relevant. Opinions are like armpits; everybody has a couple of them. If you haven't had the actual experience you're just presenting someone else's knowledge as your own. It would be nice if you could solve the addiction problem through Googling, but it's a little more complex than that.

This is my reason for sharing my sub stories. While they may be from my own personal experience and certainly do not apply to all people, it may give some others that are deciding which route to go some "real person" information to take to their Dr. Everyone has to choose the best option for themselves, but it is very beneficial to get someones experiences opposed to reading the clinical perspective. I did tons of research and not one thing I read told me about what I would "FEEL" OR "EXPERIENCE", so board members inputs (and encouragement!) were extremely helpful and I dont' think I would have made it without some of the suggestions I got on this very board.

Agreed!

I am confused as to how you would replace Norco with Sub? Sub is not a "use as needed" type of drug, so using it when you have a migraine wouldn't be very effective.
I guess I don't see why you are taking Sub unless there is a history of abuse or tolerance.
I may be way off base, and apologize if I am.

She's currently on 80mg hydrocodone a day, so I expect there are tolerance issues. She is wanting a long-acting med to do the tapering, which is understandable since tapering directly from hydrocodone (which always seems to be combined with APAP) could be difficult.

Whether buprenorphine is the ideal drug for this, I'm not sure. A viable alternative would be to gradually replace the 10/325 hydrocodone/APAP pills with 7.5mg pills, 5mg pills and so on. It could even be done by just replacing one pill a day with a weaker one, and then replace 2 pills a day, and continue in this fashion.

When tolerance is down to around zero, it then wouldn't really matter whether hydrocodone or buprenorphine is used for acute pain attacks. Ideally, buprenorphine doses would have to be 0.2mg - 0.4mg for acute pain.

The ceiling effect is a product of it's mu antagonist properties. Once past this ceiling effect, antagonism starts to take over. This produces the withdrawals. Just so you know.

More importantly, I didn't say that DHC was better for tapering. I said it was better for quitting 'cold turkey'.

In addition to a BPharm degree, I am currently conversant and informed about this subject because of my unfortunate, lenghty personal history with substance abuse.

Of course you should; everyone should. In fact, one should double-check what your doctor says and prescribes before you do anything or take the meds.

About the only time you can't do this is when you find yourself unexpectedly in the operating theatre requiring an emergency operation. All you can do is pray that a good surgeon cuts you up.

Nephro, I have provided constructible, verifiable information. If you can come up with something that shows it is incorrect, then go ahead.

Your dr is the only one who can tell you that. I dont thinks this thread is appropriate for asking how to manage your pain and side effects. Suppose someone doesnt know anything about a drug and just orders from the internet (this is just an example Im not accusing anyone of this) but if they didnt know and lets say follows someone's advice and then gets incrediably sick or worse? Sorry people Im just giving my 2cents. Again I am not targeting anyone. Nobody here is a dr that can give advice for each individual without even knowing who they are/what their past history is/what they are currently taking.

Rose

You are absolutely correct, you should listen to your doctor, then check out what he has said from some reputable sources to make sure he's not got it wrong.

Tranylcypromine is indeed the most dangerous of the MAOI's if you look at them relativily. However it's safe when used correctly. The risk of hypertension is about 1% when following proper diet.

Promethazine IS abused. That's all there is to it.

True. Hey where did my original post go? All that is left is this partial quote. Oh well, no matter.

I don't know! I did only quote part of your post because I wanted to reinforce that part of it, but I remember there was much more to it than that.

One or two of my posts have been 'trimmed' as well.

Glad I am not going crazy. But back on topic sort of, I agree w/you that folks should double check what their doctors tell them too.

None of this should ever be taken lightly. Serious stuff.

I just noticed this too. Some of my posts were edited not by me, Im thinking maybe admin intervened on the petty flaming stuff? I dont know just an idea

I went crazy a long time ago. So join the club LOL

It is now somewhat difficult to follow the discussion on this thread given the edits but I hope the basic cautionary message survived.
I am still interested in hearing about the results of the original poster's attempt to lower her opiate tolerance by switching to a prescription for Subutex.
Hopefully, she will return to this conversation and share her experience.
I will refrain from using the inappropriate "LOL" complimentary close out of respect for this original poster who unfortunately saw her subject veer off of the rails here.
Please accept apologies for my part in that off-topic occurence. At times, however, I believe it can be worth the time and effort to interject cautionary comments in a sincere attempt to address problematic misinformation when it is posted.

Hey Martin it started off bad between this one person and I tried to get people to tone it down but to no avail. Sometimes these boards can be brutal and misctonruted. Thats why I had to step it, but you werent the only one doing flaming. I wouldnt worry about it....people forget in time I suppose. I just felt bad for her asking advice but at the same time she shouldnt have brought up how to take them with her other stuff without talking to her DR. Im glad the flaming is gone though. Admin is just doing there job