I know about bupe being used for pain before addiction, but I was under the impression that it’s not all that great as a painkiller because of its partial agonist/antagonist qualities — it only works up to a certain point, unlike most opiates where you can basically keep increasing your dose and get increased results. Because of this “ceiling effect” (which is at about 32mg), if you have severe pain or have been taking strong opiates for quite awhile, I wonder how well it will help. But, as with everything like this, it’s different for each person.

I know when you’re on a medication like methadone with a VERY long half-life, you have to go a few days off it before switching to bupe…but if you’re currently on a short-acting opiate (or can be switched to one — switching to regular oxycodone from time-released oxycodone like oxycontin, for instance), you can make the switch much, much faster, since the shorter-acting opiate will leave your body much more quickly, so you don’t have to wait nearly as long to be in full withdrawal and take your first bupe dose. I’ve read that 24 hours should be plenty of time to wait after taking your last dose of a short-acting opiate, compared to multiple days with methadone.

All that being said, I can see one HUGE reason why your doctor might want to try bupe before methadone — it’s far easier to see if bupe works for you now than it would be to try it after you’re on a high dose of methadone. You’d have to taper down to 30mg from whatever dose you had titrated up to, then play the multiple-day dopesick waiting game to switch to bupe…it’s FAR easier to try it now and then simply switch over to methadone if the bupe doesn’t work for you. Good luck!

I think there’s a lot of politics involved too, because there’s so much overlap between people who are getting chronic pain treatment, and people who are dealing with addiction issues.

Do the doctors think you have an issue with addiction at all, or do they REALLY think bupe is your best bet for pain? Considering it’s only a partial opiod agonist, I believe it’s pain management abilities are somewhat limited, especially if you’re switching from strong opiates. I’ve been afraid to switch for this reason, along with the fact that I’d have to slowly drop my methadone dose to about 1/4 of where it is now AND go into full-blown withdrawal (multiple days without any methadone at all) to make the switch — a lot to go through just to find out if it works for me or not!

Keep us updated, but if I were you I’d try my hardest to convince the docs to try you on methadone first…it’s almost guaranteed to work for you as compared to bupe.