DOSE:	4 mg	insufflated	Pharms - Buprenorphine	(liquid)
	1 mg	insufflated	Naloxone	(liquid)
			Hydromorphone
			St. John's Wort
			DXM

BODY WEIGHT:

170 lb

The Art of Buprenorphine

I have used both 2mg and 8mg suboxone (buprenorphine/naloxone) tablets and films for several years and have learned several things about them. The first is I never take them sublingually, or under the tongue, anymore. The second is how much other medications like St. John's wort, grapefruit juice, dextromethorphan HBr, and cimetidine/Tagament influence the effects of suboxone. After trying methods which include sublingual (under the tongue), injecting in a vein, snorting the crushed up pill, rectal syringe with suboxone dissolved in wine, basifying suboxone with baking soda then trying to smoke it, and nasal mist with suboxone dissolved in wine: the nasal mist with suboxone dissolved in wine was by far the best route of administration. The wine used is a low tannin wine with moderate alcohol content (10-13% alcohol by volume), like a white zinfandel.

My first introduction to buprenorphine medication came after using subutex (with no naloxone) to transition from a daily intranasal 10mg hydromorphone hydrochloride/Dilaudid habit. I now use suboxone regularly to allow me to live without desire for both full agonist opiates and alcohol. Buprenorphine medications are now my general drug of choice which I can use throughout my life for the time being until I move onto something new.

I found transitioning to subutex (or suboxone) was much easier if I followed all the recommended guidelines for switching from a full blown agonist opiate like hydromorphone/Dilaudid. However one problem I encountered was totally abstaining from a full blown agonist (like hydromorphone/Dilaudid) after starting subutex/suboxone was way too harsh for me. After waiting more than 24 hours from opiate use and starting my first dose (nasal spray 2mg) of subutex/suboxone, I find using my full blown opiate agonist again after the subutex/suboxone was already in my system helped the transition a lot. This was not recommended by my doctor but it made things so easy and sometimes it totally saved the day when things got super bumpy trying to introduce subutex (or even suboxone) into the mix. Plus overdosing once subutex/suboxone was in my system was much more difficult so sometimes I wonder why this technique of following up for a short time with a full opiate agonist while suboxone is being introduced is not recommended. Yeah I know the idea is to kick using strong opiates altogether but its all about doing things slowly and gradually when trying to expel opiates from my system.

The first week of using subutex/suboxone I use 4mg subutex/suboxone in the morning and then follow it up with hydromorphone afterwards and then use 4mg subutex/suboxone in the evening and follow up again with hydromorphone if needed. I always use the subutex, or suboxone, at least 20 minutes before following up with a full blown opiate agonist. Once I have 8 mg of subutex/suboxone going in me per day for about seven days, dropping off my hydromorphone use is like nothing at all. The positive effects of the hydromorphone will become unnoticeable anyways after about 3 days of subutex/suboxone.

The most important thing about opiates (including buprenorphine) is the method of drug delivery. As a general rule I am finding out that the nasal mist method works amazing well for all opiate drug delivery times of need. Yes sniffing powder works well too, but I prefer having the drug already dissolved in ethanol before entering the nasal cavity. Basically I dissolve the desired opiate (including buprenorphine medications) in one milliliter of wine with a dash (100 milligrams or so) of glucose (from a brewery supply store). The glucose is to improve drug absorption and I find it helps counteract the bitterness, but could be only on a mental level rather than actual science.

The container I use for preparing the drug solution is the small cap (I get the clear kind and not the colored opaque kind) that comes with an Afrin pump mist nasal drug delivery device. I make sure not to get the nasal sprayer but get the 'pump mist' from the local over the counter pharmacy section. The total volume of the pump mist cap is about 2 milliliters total and one milliliter of liquid to deliver into the nasal cavity is about the maximum liquid quantity I would want to mist into both nasal passages combined at one time. Taking more than 2mg to 4mg dose of buprenorphine twice a day (for a total dose of between 4-6 mg buprenorphine per day) generally does not result in any increase effects of buprenorphine. Actually taking more than 4mg a day of buprenorphine actually seems to lead to a greater decrease in effects for me and I dread going above a 4mg total dose a day.

The ideal nasal mist solution volume should result in about ten pumps of the sprayer or less, or else I will flush too much liquid up into the nasal cavity and lower drug absorption through the permeable nasal tissue zone. The most permeable nasal tissues are located behind the eye socket so I aim for that area when pump misting (which usually that results in the most stinging sensation too). Each individual pumping delivers about one-tenth to two-tenths milliliters. I could buy a small 15ml capacity container and make a larger mother liquor of drug solution to use during a week's time but I am afraid of using it all at once if I have it ready to go, so making it up individually works well enough.

After cleaning out the pump mist sprayer, I fill the nasal cap half way up (about 1ml) with wine, add a pinch of glucose/corn sugar/dextrose to the wine, or about 100mg, and add a crushed suboxone pill or film (2mg buprenorphine dosage quantity is great for me) and stir with a toothpick or something similar. I use the skinny plastic tip which sucks up the liquid in the pump mist to stir. I have found ethanol and glucose/dextrose offer decent effects so far and have yet to try adding cyclodextrins or thickeners. Thickeners would make the solution stick in the nasal cavity better allowing one to use less total drug but have yet to try it.

The resulting drug spray liquid should be about 5 to 15 percent alcohol (depending on the wine) and be slightly cloudy. Heating helps clear the solution but it is way more trouble than its worth. I am able to suck up every last drop of solution out of the small pump mist cap by sucking it up into the pump mister while spraying the mist into the nasal cavities. I end up having to spray a total of ten times (5 sprays per nostril) in order to use the whole suboxone-wine solution. Every pump mister is a bit different so I do trial and error to determine ideal liquid quantities to use. The alcohol will create either a very slight to strong stinging sensation in the nose based on how concentrated the alcohol solution I am using. I like just a little tingling and stinging sensation because I can tell where the spray is landing inside my nasal cavity. Also ethanol most quickly diffuses through mucous membranes at around 12 percent concentration or so in water so I assume this 12 percent concentration of ethanol in most average wines is just about optimal. The nasal solution will want to drip back in my throat so it helps to invert (hang upside down) to allow the liquid to trickle up into the upper regions of the nasal cavity. Usually a good spray feels like I am spraying up behind my eyeballs, making my eyes water a bit.

Also I find taking 7 gel caps of 300mg St. John's wort one hour before using 2mg suboxone changes the experience of suboxone for the better for about a month’s time. After a month I quit taking the St. John's wort with suboxone and switched to another potentiator like Tagament or dextromethorphan HBr. Taking 300mg of Tagament (cimetidine) one hour before the suboxone mist also changes the suboxone experience for the better for a time, until I again switch potentiators. Suboxone turns into a whole new drug in an incredible combination that I use sparingly about once a week which uses 300mg of Tagament (cimetidine) at time 0:00, followed by 150mg of controlled -elease Delsym dextromethorphan polistirex at time 1hr:00min, followed by 2mg of suboxone via pump mist at time 2hr:00min. The quantity of dextromethorphan I use in this dosage scheme keeps me just below the 1st plateau. Doing the dosage scheme once in the morning then again in late afternoon will put me in an interesting state for the entire day. This still allows me to interact socially with other people without appearing overly drugged, however everybody reacts differently so do not assume this will work for you.

Totally abstaining from suboxone use is most easily achieved using Delsym cough syrup which is a controlled release suspension of dextromethorphan polistirex in combination with Tagament or grapefruit juice. Taking 100mg Delsym cough syrup with 300mg Tagament or grapefruit juice as needed during the worst time of drug withdraw works the best for me to kick suboxone use.

Exp Year: 2011	ExpID: 93591
Gender: Male
Age at time of experience: 29
Published: May 29, 2019	Views: 8,694
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Pharms - Buprenorphine (265) : Combinations (3), Retrospective / Summary (11), Addiction & Habituation (10), Preparation / Recipes (30), Various (28)