Micro-Dosing to get started on Suboxone

[@MiguelRodriguez-nd6xy]

This works, folks. I did a ten day detox, quitting street drugs on the fifth day. Day one was .25 × 2. Increased to 3mg ×2 on day five. Worked backwards from here, .5 off the day's before dosage. Day ten was a piece of cake with no withdrawal significant. On the third day, I did go through a bit of discomfort, but nothing that was too bad. Now my problem is sleep, which I know will come later. Right now, I'm just enjoying these days of peace.

[@shanteshante811]

Like I started today and it was bad after a few bumps of doc, I was back to normal but I’m afraid to continue should I?

[@drw505]

How often did you take the street drugs that's where I'm getting a little lost I like what you said just need to know what I need to do cuz I want to get off but I'm scared

[@OdelinSerrano-zu5fo]

​@@drw505Be courageous, my friend. I was doing three to five bags a day. Some days that was doubled. This method must be done slowly, or you precipitate. For me I started with 1/4 of one Mg every twelve hours. After two doses, I went to half a mg, every ten hours. For my third day, I took .75 of one Mg × 2, dropping them every eight hours. So, as I increased dosage, I decreased time interval. When I got to 3 mg × 2 a day, I was dosing every six hours, and got off the D. Not one sign of withdrawal. At this point, I worked backwards, a mirror image of what I had just done, just backwards. I recall four days after being off everything, my energy level was crap, but I was able to walk outside for fresh air. For heavy anxiety, I smoked weed. That may be a problem for some, as weed may increase anxiety and paranoia. Whatever works, my friend. There's a video that explains how immodium can also help withdrawal. If taken with clear grapefruit juice, loperamide, which is the active opioid in immodium, will remove the withdrawal. This method can help, but higher tolerance is fast achieved, meaning that constant use of this will render it ineffective at low dose. The grapefruit juice disables the blood/brain barrier, allowing the opioid to reach the brain. Even without the juice, loperamide does help with withdrawal, especially the gastrointestinal symptoms. Gabapentin is also known to help with withdrawal. Do research, my friend. Do NOT quit. Try every tool and every trick available. Adopt the attitude of looking at failure as nothing more than an idea or strategy that did not work for you. Combine different approaches to different problems. There are plenty of meds to help in the initial few weeks. Use them WISELY so as to not develop another habit. God bless you.

[@IMAWOMANDONOTDOUBTME]

What do you need help with? Im trying to kick again right now. I have a few times. ​@@drw505

[@mindycarpenter1229]

Thanks to this kind Doctor taking his time to respond to my message saved my life I’m now three days sober

[@dr.grahamchelius9087]

Awesome. Buprenorphine is not recovery however, it just helps people stay in recovery. You deserve a good recovery program. Also, we all make mistakes, time to forgive yourself and move on.

[@utrube]

Thank you doctor for taking your time to answer this important question and us getting the answer from legitimate person as you are clearing some doubts about this procedure. I'm getting mentally ready to start the process and gain little bit more freedom being on Subs instead on Methadone. Thank you

[@dr.grahamchelius9087]

YES, this method also works for methadone! This is a great point that I have not emphasized enough. If you have trouble with the microdosing, please watch my "having trouble with microdosing?" video I made a few months ago. It will help. @@utrube

[@mikecastro4923]

@@dr.grahamchelius9087 Hey doc im over 48 hours off methadone with only minor withdrawl, i did a weird taper for a month prior where i would stop for a day or two and each day i did dose i decreased from 100mg to the last dose being 40 mg then finally stopped after many years at 100mg…should i just keep staying opiate free or do u think i should induct bup then detox from that? I wanna be clean i have awesome recovery skills and ppl that love me and mentally ive gotten stronger…i just want to be safe with all this so i cant start my new life opiate free.

[@jeanclaude1916]

i want to get sober so bad. i have subs but i’m terrified to take them again due to precipitated withdrawal… the first time i tried to get sober, i had been without for 3 days and felt an instant relief the first time i took a sub.. now i’m afraid because i went thru it after 24 hours without

[@dnyce1943]

Dude where are you at why can't I have a doctor like you you seem so cool and just understand the mind of an addict wish I had a doctor that could understand me and better ways

[@dr.grahamchelius9087]

Hawaii...

[@These-nutz]

Excellent advice, thank you, makes sense

[@anthonysegovia]

Hello Dr, i love this video. Can you please guide me with proper micro dosing , i would like to start tomorrow.

[@dr.grahamchelius9087]

My patients begin with a 1/4 piece of a 2 mg tab once a day (0.5 mg) and double the dose every 48 to 72 hours while still using their usual opioid dose until they are at least taking 16 mg a day, this takes 12 days minimum.

[@anthonysegovia]

Thank you Dr. Currently i am prescribed 8MG tablets

[@dr.grahamchelius9087]

That size is tough to cut to a low enough dose to avoid withdrawal if doing microdosing. Some people have told me they tell their prescriber to watch the video and then they can get the 2 mg tabs. The 8 mg films might be able to cut down, but each 8 mg film would need to be cut into 16 pieces…

[@misterdemocracy3335]

Good video. A lot of people, including myself, didn’t know about this stuff until very recently because all our information was outdated due to the changing drug ecosystem and the rise of fentanyl and weird analogs and synthetic opioids. It’s really a shame you can’t just be a normal old boring heroin addict anymore, it’s all this crazy shit that people really struggle to get off of using the standard methods.

[@dr.grahamchelius9087]

Well said, although to be fair, the same issue exists with methadone. The tragedy is that we struggled to get people transitioned off methadone and on to buprenorphine for years (since '03 ish) and this microdosing method did not become well known until recently.

[@Matthew-z4r]

What do you mean the longer i wait the worse what is dr I just don't wanna go into PW is all

[@doorlagr]

Are you familiar with cerebrolysin? There have been a couple studies that have shown it to reduce both the length and severity of opiate withdrawals.

[@dr.grahamchelius9087]

Here is my unpopular opinion: Stay on opioid replacement/ maintenance until you have made enough progress in recovery that you have substantial experience and trust in your non-chemical coping mechanisms, then gradually taper buprenorphine no more than 1-2 mg a month until down to 2 mg then slow down to 0.5 mg reductions a month until off...this gives you enough time to have some shitty events test your recovery skills... Overall, controlling withdrawal is the easy part, we do not need to keep searching for new methods, buprenorphine works, and is easy to taper off if done correctly...the hard part is investing the time and energy into recovery work...so that you have non-chemical options when craving, stressed etc...

[@adrianeyre3630]

You’re confusing the situation here so do you continue to use on top of buprenorphine or not and if so how much heroin?

[@dr.grahamchelius9087]

The microdosing technique is a very gradual introduction of buprenorphine WHILE YOU CONTINUE TO USE YOUR USUAL DOSE OF YOUR OPIOID OF CHOICE. Usually people use microdosing when they use fentanyl or methadone, not heroin. If you use heroin, test it for fentanyl, if negative for fentanyl, then transition with the usual method, waiting 12 hours or so and then start full dose buprenorphine.

[@kingkdpc8648]

All right Doc, I haven’t seen anybody else in this comment thread say it yet so, I guess I’m gonna be the first. Hi… I am ABSOLUTELY terrified of using subs. Reason being one of my closest friends who takes the same M 30s as myself recently went and got put on Suboxone… At least from what he told me he waited the correct amount of time he was supposed to before taking it which was about a little over 24 hours. He Went into PW For two days. No, I wasn’t with him, I’m not sure if he stuck to the schedule that he was supposed to BUT The only time I ever used subs I used less than a qtr mg and weather to die… so… I desperately want to get off of the percs

[@dr.grahamchelius9087]

A few points: 1) It can be difficult to tell the difference between precipitated withdrawal and just regular opioid withdrawal because of a suboxone dose that is way too low. If you stop heroin for example, hour by hour the withdrawal will get worse and worse, and if you take too little buprenorphine (AKA "suboxone") the withdrawal will continue to get worse hour by hour... 2) The way we were trained back in the early days ('07) was to start at 4 mg and have patients come back every day for a little more until you were at 24 mg a day or they felt better. Well that sucked and many patients were miserable due to underdosing for days and gave up and went back to regular opioids. The early adopters like me figured out pretty early that you are way better off giving an adequately large dose the first day...so most my patients are taking 8-16 mg their first dose after 15 hours off short acting opioids. 3) I have been prescribing buprenorphine for 15 years and have treated thousands of patients, I currently have over 200 patients on buprenorphine, and with few exceptions I can find a way to comfortably start people on buprenorphine. However, yesterday someone came in completely broke, relapsed using fentanyl, and just did not have the money to: A) microdose as in the video or B) change to heroin or some short acting opioid for 5 day (and it is illegal for me to prescribe). So the only path was to begin microdosing for 5 days off all other opioids which would definitely be miserable, and control nausea with zofran, and then begin 16-24 mg a day of Buprenorphine after 5 days off fentanyl... So sometimes to save your life you need to take one for the team...so to speak...and tough it out. People have sweated thru their opioid withdrawal in jails the world over for thousands of years, it sucks but when you have no there choice it can be done.

[@bobpelley5093]

Good luck with that!I prefer methadone.Atleast it is a full agonist opioid-like fent.Rather just use regular dope (H).God how I miss a good shot!Never in a million yrs did I think H would disappear.😢

[@dr.grahamchelius9087]

A) Methadone is not available in most communities, for example Kauai. B) People can't get off methadone like they can taper off Suboxone. C) Some people are not ready to quit. They fantasize, rationalize, and minimize.... Sound familiar? Heroin has taken everything from so many people. It reminds me of people with a violent partner, they are being hurt, but can't get out... D) When you are ready to quit fucking around and ready to stop letting a chemical run and ruin your life... Then you are ready.

[@bobpelley5093]

@@dr.grahamchelius9087 oh my gosh,surefor shore doctor go a big mean ol potty mouth.

[@richardrardin9156]

Dr.Graham, (OR ANYONE WITH EXPERIENCE IN THE MICRODISING METHOD) how is this for a starting schedule? Day 1- 0.25mg AM Day 2- 0.25mg AM&PM Day 3- 0.5mg AM 0.25mg pM Day 4- 0.5mg AM&PM (POSSIBLY STOP FENT USE) Day 5- 0.75mg AM 0.5mg PM (DEFINITELY STOP FENT USE) Day 6- 1mg AM&PM Day 7- 2mg AM&PM Also, I have been down to only been snorting about 0.25/gram to, I'd guess ehhhh, like 0.6/gram a day? And I'm going to go down by 0.10 / gram per day as soon as I start the dosing. Is there anything wrong with this schedule or anything else I described? Or does this sound pretty legit?!?!? Should I stay using fentanyl longer than the day 4 mark? I'm still going to be scared of precip, and I've read like 2 or 3 comments where ppl got all the way up to the 2mg point and felt some precip. I'm pretty sure those ppl didn't keep doing enough dope though after they started the microdosing. When I stop using when I get my 2mg day, I'm going to make sure that I have a dope boy on standby and money in my pocket, JUST IN CASE I go into precip. I don't wanna just have dope laying around lol.....and it'll be AMAZING if I have 40 bux in my wallet and I'm able to buy something cool instead of Fent.....lmfao like maybe order some Chicken Fil A or Five Guys thru Door Dash? Lmfao

[@dr.grahamchelius9087]

Thanks for reaching out, sorry for the delay in getting back to you. Honestly, I can't say that 2mg of buprenorphine a day is going to be enough to cover your dose of fentanyl. First, I usually don't ask exactly how many mcg/ grams of fentanyl people are using due to huge variation in actual potency. In reality my patients have no idea what they are getting (which is why fentanyl is so dangerous) and neither do I. There is something more important however, you want to be FULLY BLOCKED. Do not take less than 16 mg a day of Buprenorphine when you are initiating buprenorphine treatment. You want so much Buprenorphine that it is fully occupying your opioid receptors so when you have a tough day and you relapse...the Fentanyl is not effective and you have to wait for the blood level of Buprenorphine to go low enough, by that time hopefully you get your motivation back and stay on track. Stay on a high dose of buprenorphine long enough to get good progress in recovery, and get used to not using. Watch my "I hope something shitty happens to you video"... And my "Suboxone is a training program for the rest of your life" videos. Real talk...Buprenorphine can save your life if you use it correctly, Go long and strong...

[@richardrardin9156]

@@dr.grahamchelius9087 hell yeah, I just left my schedule off at 2mg cuz I was more worried about the beginning of the I duction and not going I nto precip .... When I was in a detox, 4mg in the AM and 2mg at about 8 o clock at night worked good for me.

[@dr.grahamchelius9087]

@@richardrardin9156 I just want to be clear that the dose to control withdrawal is not the target dose...that is the old way of thinking...the new studies show that high dose to achieve full blockade of opioid receptors is the target dose.

[@Matthew-z4r]

Dr this is Matthew again I took a 0.5 at 1.30 a.m. a hour ago almost I don't feel worse I believe I feel better when should I take next dose and how much Dr. Can I just go back to my regular 2 mg gram doses now or go slow. Or can I take 0.5 every 2 hours now till back at my regular dose I took a 0.5 at 1:30 a.m. Chicago time and I feel way better no pw can I take more every 2 hrs now till I'm back at regular dose

[@bigs_113]

Doc I’m still on Heroin live in Southern California there’s still H (black tar) I test my stuff it’s not cut . So what advice (I know you’re not telling me to do something) just want some advice of what you would tell your patient with a heroin problem still , how they would micro dose and how long and how much should I still use as I’m microdosing ? I’m on 2grams of H daily and the stuff isn’t great I got the low grade stuff specifically so I could not be strung out on the super good H .

[@dr.grahamchelius9087]

Heroin is a short acting opioid, so generally someone will not need to micro dose to get started on buprenorphine, they would just take their last dose of heroin at 6 PM, and start on buprenorphine at 9 AM the next day (or whatever, as long as it is about 15 hours and the person is in moderate withdrawal, which is a score of at least 13 on the COWS- Clinical Opioid Withdrawal Scale). plan on taking at least 16 mg a day of Buprenorphine, and for several months to several years to allow for enough progress in recovery to occur so that a taper does not result in relapse. That being said, expect relapses, keep them short, don't get discouraged, don't give up. You deserve to get this behind you. It will take investing in yourself, watch my 3 walled prison video for a framework to pursue recovery. Give the buprenorphine plenty of time to absorb under the tongue, 20-30 minutes, I have other videos on how to take/ prescribe suboxone/buprenorphine that are more detailed.

[@jelsondebbarma75]

I am not saying to stop the buprenorphine because I feel terribly chronic pain thus, i suggest giving up the buprenorphine typically much more difficult and I have been struggling for more than 8 months of buprenorphine. Thus, I gave up the heroine but yet buprenorphine was not possibly stoppable.

[@bobpelley5093]

Really!I live in Tucson and know a few street addicts.They say the H is long gone here.Be grateful even for some crap real dope...its gone everywhere else.God how I envy you (ese?)...gotta be.

[@bobpelley5093]

​@@dr.grahamchelius9087Heroin is a medium time acting opiate,lasts 6-7 hrs.Not short acting like You said.Fent is a short acting opioid,lasts 2-3 hours.Heroin is an opiate.Fent and methadone are opioids-100% synthetic.You might have a degree yet I'm not sure about your cognitive integrity.Use appropriate language so people will not be confused by you.Please feel free to reply...😢

[@kimlizzotti4878]

Great video

[@These-nutz]

Thank you Dr. god bless 🙏

[@dr.grahamchelius9087]

I hope things are going well

[@These-nutz]

@@dr.grahamchelius9087 yes they are, I did this 4 months ago then switched to Kratom, it wasn’t that bad really, still clean except for Kratom, I plan on jumping from it soon, 3 years ago I jumped off 100 mgs of methadone after 20 long years, I did that cold turkey until day 25 and bought Kratom because I was going crazy from no sleep, I took Kratom that time for 4 months then stopped, when they had the shut down I slipped for almost a year that’s when I did the Bernese method, your video gave me hope!! Thank you Dr!!

[@dr.grahamchelius9087]

@@These-nutz awesome

[@jeffcalidrone5931]

Thank you doc. I started microdosing Im up to 2mg bid by increasing .5 daily Tommor Im going to go to 3mg bid and increase to 6mg bid by adding one more mg bid every day. I felt some withdrawal when I took 2mg this morning do I just continue the program and work through the withdrawals they are not near as bad as last time I precipitated withdrawal. Thanks for your time and help.also I read that after 6mg bid I should stop the fentanyl

[@dr.grahamchelius9087]

Fentanyl is so potent that it takes a lot more Buprenorphine to match the effect. I usually shoot for at least 16 mg a day before stopping the fentanyl. Great work with the slow ramping up. Generally increasing every 48 hours by doubling works OK, if some withdrawal occurs with an increase in the dose, it may be better to wait 24 hours longer or increase by 50% rather than double...for example 4 to 6 mg a day rather than 4 to 8 mg ....

[@jeffcalidrone5931]

@@dr.grahamchelius9087 thank you doc I’m at 4mg bid today three more days I’ll be out of fenti pills. I’m not getting any withdrawals really just some aches and pains it’s starting to block them I can tell. I look forward to running out and being just on subs that will be the 8th day ramping up to 14mg daily I know I can make it from there. Thank you for responding. Really appreciate that 🙏🏼

[@jeffcalidrone5931]

I microdosed all the way up to 16mg and when I stopped the fentanyl I felt so sick so I added more suboxen and ended up still precipitating withdrawals so bad I wanted to kill myself. Literally. So I fucking relapsed because I couldn’t deal with the pain etc. I really want to quit these fentanyl pills are killing me and my family. What can I do to get through them without feeling like I’m actually dying (my lungs gurgling and I feel like I’m not getting enough oxygen ) or actually shooting myself in the head. I’m so depressed I don’t know what to do. I’m embarrassed to tell my suboxen doctor that I relapsed so I haven’t followed up. You have any words of wisdom for me? Can I retain you as my doctor? Much love. Jeff 714-655-6228

[@dr.grahamchelius9087]

@@jeffcalidrone5931 Jeff, first, please do not harm yourself, this is fixable. Second, I want to be clear that I am not giving specific medical advice, just trying to educate the community, OK? As I mentioned a week ago, fentanyl is way more potent than anything else, causing high levels of opioid tolerance and thus requiring very high doses of buprenorphine. This reminds me of 12-13 years ago when pill mills were running and people would come to see me and were using 1000mg, 1200mg of morphine a day...I would regularly see people who needed 4, 5 or even 6 tabs a day of 8 mg buprenorphine to control the withdrawal...initially, then would reduce the dose to normal doses in a few weeks or months. I am giving a lecture tomorrow and plan to talk about exactly this problem...so thanks for sharing your story, it helps me. Unless you are physically in Hawaii, I can't take you as a patient, and even then I virtually never see someone who is not on my island, but I am trying to help as much as I can, thus the KZbin channel... Finally, I always thank my patients who tell me they relapsed and need help. I explain that many don't and end up dead or in jail, and that really hurts me. I don't understand why my patients don't trust me enough...I don't know what else to say or do to gain their trust. Please open up to your doctor, as I hope my people open up to me. Good luck, keep in touch

[@Danielle-zy7un]

So I was taking the 24 mg but it wasn’t enough so it could be possible that I’m just not on a high enough dose of bup? And possible need more?

[@Matthew-z4r]

Dr this is Matthew I commented yesterday I'm at 25 hrs i relapsed for 4 days from heroin I used maybe .4 Im a regular Suboxone user my last dose Suboxone was Saturday morning I relapsed Saturday night I barely felt the heroin untill last two days should I wait 48 hrs to start cause I don't want pw. Or sense I already had Suboxone in my system should it of knocked most heroin off my receptors I'm confused please help Dr. Can anyone help me

[@dr.grahamchelius9087]

Just go ahead and take the test dose, the longer you wait the worse it is.

[@jamesons6770]

Thank you for this video and all your other ones. If you could please shed some insight into the issue I keep having w microdosing...Im a street fent user for last 2yrs, 10yrs total for all opiates/opiods. I've attempted microdosing 2x recently to get off dope. I do well until I build up to about 4mg-6mg and then I feel WD symptoms somewhat intensely. Is this normal? Do you have any tips for me to successfully taper up my sub while tapering down my dope? I'm so ready to be over this habit.

[@dr.grahamchelius9087]

Just to clarify, the idea with microdosing is that you DON'T reduce your usual opioid until you have reached an adequate dose of Buprenorphine. If someone is using a more potent opioid (fentanyl) or larger dose they will require 16-24 mg of Buprenorphine before reducing their usual opioid. So, please clarify if that does not help. Additionally, everyone is wired in their brain a little different, maybe someone needs to double the Buprenorphine dose every 3 days rather than every 48 hours...

[@jamesons6770]

@@dr.grahamchelius9087 I "misspoke" I was not reducing my opiate dose during the microdose induction. While I was experiencing WD symptoms they were not extreme but quite uncomfortable. Does this method reduce WD symptoms completely? Any tips on how I can complete it successfully?

[@jamesons6770]

@@dr.grahamchelius9087 oh and thank you for taking the time to answer mine and everyone elses comments. 💯👍

[@dr.grahamchelius9087]

@@jamesons6770 Were you using suboxone or subutex (plain buprenorphine)? Some people are sensitive to the naloxone in suboxone...

[@jamesons6770]

@@dr.grahamchelius9087 these last 2x I used Suboxone and the time just prior to this I was in rehab and got PWD from Subutex during my Subutex induction. I gonna try again tonight to start a Suboxone microdose induction and I will take ur advice 2 reach dbl dose every 4days. I was gonna start at 1mg or u think that is 2 high?

[@mikecastro4923]

Hey doc im over 48 hours off methadone with only minor withdrawl, i did a weird taper for a month prior where i would stop for a day or two and each day i did dose i decreased from 100mg to the last dose being 40 mg then finally stopped after many years at 100mg…should i just keep staying opiate free or do u think i should induct bup then detox from that? I wanna be clean i have awesome recovery skills and ppl that love me and mentally ive gotten stronger…i just want to be safe with all this so i cant start my new life opiate free.

[@dr.grahamchelius9087]

I am curious how things are going. I would guess that now the long acting methadone is really starting to wear off and you are in opioid withdrawal. Usually I have my patients who are taking methadone wait to start suboxone 7 days if they are taking 30 mg or less, and 14 days if they are taking 40 mg or more. Methadone takes a really long time to get out of the system. I always check a urine drug screen to make sure it is negative for methadone before inducing someone. If you are in withdrawal now your best bet is to begin buprenorphine micro-dosing. People can get stuck where there is enough methadone in their system that they can't get started on buprenorphine with out causing precipitated withdrawal, but there is not enough methadone to keep them out of opioid withdrawal. If that is the case, restart the methadone at the lowest dose that controls withdrawal and begin micro-dosing on suboxone/buprenorphine.

[@mikecastro4923]

@@dr.grahamchelius9087 doc! So my clinic said 4 days and i was insanely sick! I thugged it out though! It’s been 26 days no methadone but unfortunately i still have to work so i tried again today and boom it worked! I didnt taper slow enough so i was still testing positive on day 17! Im 5’9 240Ilbs so it im sure it takes me longer no underlying health issues only thing is i stopped cus i was constipated n since i been clean for 7 years i chose to rapidly quit for relief but the precip withdrawl really messed my stomach up it burns and hurts and diarrhea all the time! I feel like my insides are toxic! Do you have any thoughts on how to calm my stomach…GI said ibs and constipation smh

[@mikecastro4923]

@@dr.grahamchelius9087 i only took 3mg, i tried 3 mg of the dr reddy n nothing so i took a name brand and it helped my body

[@jemmysmith8661]

this works with red vain kratom in place of the subs-

[@Matthew-z4r]

Hello ive been using Suboxone for awhile now ive been taking 4mg a day. I relapsed Saturday on about .4 of heroin over last 4 days Idk if it had fent i believe the subs knocked most off my receptors cause didnt feel alot of the high till last couple days how long should i wait to start dr. Cause i believe the subs didnt let much heroin stick to my receptors idk ?? Help please sir

[@dr.grahamchelius9087]

Usually if someone can tolerate a 1- 2 mg test dose of suboxone, they are good to go back to their usual dose.

[@Matthew-z4r]

@@dr.grahamchelius9087 How long should a wait to start the test dose

[@Matthew-z4r]

@@dr.grahamchelius9087 so it's been 24 hrs should I wait a little longer or since I wasn't using very long a few days should I be fine now to start the test dose or wait 48 hrs I don't feel bad at all so I think the sub knocked most of heroin off my receptors . Only been off subs for 4 days only used maybe .4 of heroin

[@novakjovanovic7313]

Its funny that i found this video, i sorta started microdosing on my own without ever hearing of this... I can take 1 mg and not w/d and i use 1-2 points of pure h (i know everyone says pure but this really is strong) its my first day but i think ill be able to get up to 8 mg in like 3 to 4 days and i will be cutting down my does of h as i go... In the past Ive found i can be stable on 4 mg sub (taken in the morning) and pretty much use up to a point of pure h a day (in the afternoon otherwise i wont feel it) and maintain like this without w/d if i dont use h

[@dr.grahamchelius9087]

Transitioning to Buprenorphine from heroin (heroin not mixed with fentanyl) is way faster due to heroin's (AKA diacetyl morphine) shorter half life. Generally, I recommend that my patients shoot for a high dose of buprenorphine initially, 16-24 mg a day. the goals being 1) eliminate any withdrawal symptoms and 2) Have enough buprenorphine in the body that it blocks other opioids like heroin for a long time...so if someone gets off track (a case of the F*$# -its) they have to wait awhile to use opioids and hopefully by then they have gained enough courage to stay in recovery...

[@brendafauzey7161]

I need help with micro dosing im tryimg to get off opiates im scared to start

[@dr.grahamchelius9087]

Watch this video: kzbin.info/www/bejne/opm5c6qNabuSY9U It gives easy solutions to some of the problems people have when transitioning from fentanyl to suboxone/ buprenorphine... Good luck. You can save your own life right now...

[@seidels21]

How do I get in contact with you?

[@dr.grahamchelius9087]

I am in Hawaii, 8082402721 is my office number

[@nickolashampton1903]

Does bup/naloxone 8/2 work for this?

[@dr.grahamchelius9087]

See my reply to your other comment...

[@honestauto3490]

I wish my doctor could understand this but he and I have argued over it a few times when I've tried to start Suboxone it throwed me into precipitated withdrawals and he keeps saying it's not possible after 12 hours of taken fentanyl to go into precipitated withdrawals but he's never been on fentanyl so he has no idea what he is talking about and he keeps telling me I have 20 years experience I know it's not possible to go into precipitated withdrawals 12 hours after taking fentanyl. So now I have Suboxone but every time I try to start it I go into precipitated withdrawals and I'm scared to take it again.

[@dr.grahamchelius9087]

Yes, I have learned more from my patients than from the "suboxone training", much of what they teach is good, but for long acting opioids like methadone, fentanyl etc, the training programs are really misleading. Fentanyl is used as a short acting opioid in hospitals, but it is short acting due to a high "volume of distribution" not a "rapid rate of metabolism"....and this throws a lot of doctors off...Even the information from the drug manufacturer only really discusses brief exposure...so those who use fentanyl for days or weeks or months have a real issue being understood. Anyway, people can do this on their own! Begin at the lowest dose you can, while still using your usual opioid, very gradually increase (for example, begin at 0.5mg, increase dose every 48 hours until at 16-24 mg a day,) then stop the opioid... Buprenorphine is not RECOVERY FYI...you still need the support of a community of people who understand your struggle...get to a meeting, feel and spread the love...

[@honestauto3490]

@@dr.grahamchelius9087 okay I understand the microdosing part your talking about but what about during each 48 hours do I need to cut down on the fentanyl also?

[@dr.grahamchelius9087]

@@honestauto3490 No do not decrease, for microdosing (also known as the Bernese method) the person continues to use their usual dose of their regular opioid until they reach a therapeutic dose of Buprenorphine.

[@dustinhagy1546]

Me 2 I am scared the sub is gonna make me worse 😢

[@goobersquad6008]

Wait 36 hours that’s the right time

[@jaredchapmam2494]

I went through participated withdrawal. One of the worst times of my life. I despise being on the fake 30 oxy/ fentanyl. I am going to try this. I've called different detox centers and Drs. They have no idea what I'm talking about. Do you have a video or website that has more in depth info on this. I have 8mg tablets. They are very small so trying to figure out .25 is tricky. I'm so over this though to the point I will never touch this again. It makes you a broke slave with no power. Any additional help or advice would be appreciated.

[@dr.grahamchelius9087]

Try searching micodosing and buprenorphine, lots of recent articles..like this one...PMC6970598

[@seane.9937]

I'm starting withdrawal from heroine and 100 percent truth I'm telling you that kratom with removed just about all the wd symptoms for about 6 hours per dose. You have to use gold or black strains of the kratom. Headshops have it.

[@dr.grahamchelius9087]

@@seane.9937 kzbin.info/www/bejne/b5vWiHhtbpeXbdU watch my video on Kratom, you will find it very interesting

[@seane.9937]

@@dr.grahamchelius9087 thank you Dr. Graham I just watched it. And 100 percent agreed it has saved me from a day of torturous WDs symptoms. I only had two capsules. I'm only using that until I can use the suboxone I have. There's a transition period there which is uncomfortable. Thank you for contacting me. God's Love

[@msoto3647]

Hi, im in same boat as you 😩. I know you wrote this a year ago. Did you try it? @Jared

[@Matthew-nw7ut]

This is my first time here my last dose of bup was Wednesday morning i only used. 3 of heroin idk if it had fent do you think it will be OK to start bup again now at low dose or wait cause I'm thinking the bup knocked most of drugs off receptors what do you think Dr I don't want pw

[@dr.grahamchelius9087]

There are a lot of unknowns here, it sounds like you relapsed about a week ago, and maybe there is fentanyl in your system. I would recommend that you try a rapid restart... To do this people will take a 0.5 mg dose of buprenorphine (1/4 of a 2 mg tab) and repeat it every 2 hours until they are feeling out of withdrawal.

[@Matthew-nw7ut]

@dr.grahamchelius9087 how many hours should I wait to start my subs sir

[@Matthew-nw7ut]

@dr.grahamchelius9087 at 36 can I start taking the 0.5 every two hours of sub or should I go slower it's been 28 hrs since last use now

[@Matthew-nw7ut]

@dr.grahamchelius9087 I waited almost 34 hours just took a 0.5 sub do you think I should take a 0.5 every two hours

[@dr.grahamchelius9087]

@@Matthew-nw7ut OK, keep up the good work

[@lifewithzayandzavi2191]

Hello dr today is my first time using suboxone. I have been taking fetanyl I took 0.2 today how often should I do this is it twice a day and will tomorrow be 1 mg

[@dr.grahamchelius9087]

kzbin.info/www/bejne/apuziGeIjMp7aK8si=j10aVsCGdFN7PNqK

[@dr.grahamchelius9087]

It is OK to take it slower than increasing by doubling the dose every 48 hours, can double every 3-4 days or increase by 1 mg every 48 hours, lots of differences between people. However, KEEP TAKING FENTANYL UNTIL YOU ARE AT AT LEAST 16 mg A DAY...often initially people need 4-5 8 mg (32-40 mg a day) tabs a day to stay out of withdrawal, then can reduce to 3 8 mg tabs a day (24 mg a day)

[@lifewithzayandzavi2191]

Okay so I’m sorry I’m so dumb on instructions so today I did 0.2 tomorrow how much would it be .I’m not too sure it’s exactly but I measured it kinda to that exact amount ..and other question is it ok to feel a bit of discomfort for like 20 min then go away with my first piece taking today

[@dr.grahamchelius9087]

@@lifewithzayandzavi2191 Because the smallest dose of buprenorphine that people can easily get is the 2 mg tab, usually people start with 1/4 pill once a day (one piece of one pill cut into 4 equal pieces), then take that dose for one more day before increasing. SO for days 1 and 2 0.5 mg a day, then for days 3&4 1 mg a day, which is 1/2 tab. then days 5&6 one full tab (2 mg a day), then days 7&8 4 mg, and days 9&10 8 mg a day, then next is days 11&12 16 mg a day, and you can stop fentanyl or whatever on this dose.

[@lifewithzayandzavi2191]

Thank you for all your feedback one more question so I live in sacramento I cannot find anyone that will subscribe microsdosing or subutex I can only do suboxone I have three subutex tabs myself 8mg and 20 day worth of 8mg suboxone I am just trying to stop is there any way I can take the subutex first and then suboxone

[@raypatricelli9681]

Gotto pick up my first suboxin script im on fentanyl bad habit ive tried to get on suboxin and waited 72hrs still got withdrawals so im trying again any help would be nice

[@dr.grahamchelius9087]

The Bernese method: Start very low, 1/4 of a 2mg tab/film or less as the first dose, each day increase the dose, but don't do more than double the previous day's dose. Continue to use your usual opioid, as low a dose as you can to stay out of withdrawal... usually target is 16 mg a day for stable daily dose "maintenance" until you have enough progress in recovery that you can take a beating and not relapse...or increase your suboxone dose...see my "I hope something shitty happens to you" video...

[@raypatricelli9681]

@@dr.grahamchelius9087 thank you so much

[@dr.grahamchelius9087]

@Joshua Blunt The Bernese method is when you continue to use your usual opioid dose until you reach an adequate dose of buprenorphine/suboxone, for example 16 to 24 mg of Buprenorphine a day.

[@Danielle-zy7un]

How many days should you be on this dose before stopping the fetnyal? When I tried last time I got the awful skin crawl feeling and couldn’t take it. Is there anything I can ask for to help with this that my Dr would be ok and comfortable prescribing to help alleviate these affects to get off this? Should I only be using when I start to feel bad? Not using all day just to use if that makes sense?

[@Heopful]

Bro u dont need ramp up to get "started on bupe" you 1. Take as little as possible when youre coming of H(max 2mg, MAX) 2. Stop as soon as you can (max a week, MAX.)

[@dr.grahamchelius9087]

This video is for people who are using fentanyl. Due to the short duration of actual pure heroin (Not laced with fentanyl), usually the best approach is to wait about 15 hours (last dose of heroin at 6 PM, begin buprenorphine at 9 AM the next morning), and begin the maintenance dose (usually of 16 mg a day) and continue until the person has made significant progress in recovery (see my "I hope something shitty happens to you" video) and then taper off (See my "How to get off Suboxone" video. Many studies have demonstrated that rapid taper like you recommended have very high rates of relapse (one of the first studies almost 20 years ago, for those who tapered ZERO of them stayed in recovery verses 80% who stayed on maintenance Buprenorphine.) What is the cost of staying on Maintenance Buprenorphine? Here in Hawaii, office visit every month, $5 copay every month. What is the cost of rapid taper, relapse and overdose death.... Your life is worth way more than $5 a month...

[@Heopful]

@@dr.grahamchelius9087 fent is short duration not heroin. Are you a real doctor? 16mg is way over ceiling also. "Rates of relapse" if you do it your way youll just get stuck on subs(which is only better thah h if it stops you from stealing) but people struggle with getting of them as much if not more than h. Your best bet is to keep trying to stay clean.

[@dr.grahamchelius9087]

@@Heopful www.pdr.net/drug-summary/Fentanyl-Citrate-fentanyl-citrate-2474.1127 scroll all the way to the bottom, Mean half-life ranges from 15 to 25 hours. This means after 25 hours it is 50% reduced, after 50 hours 75% reduced, 75 hours 87.5% reduced, and 100 hours 93.7% out of the blood. If you have never gone from fentanyl to buprenorphine then you wouldn't know. The elimination half-life of morphine is about 1.5 to 2 hours. Yes, I am a real doctor. Look me up. Board certified, been prescribing buprenorphine since 2007. I give lectures to other doctors on this subject... The reason I make these videos is due to real world experience from my current 200+ patients that are using buprenorphine to help their recovery today. I see people with chemical dependency all day long 5 days a week. I have a phrase that I use often: The wrong information is worse than no information. Watch my videos, learn about the topic. Stay on Buprenorphine until you have made enough progress in recovery to be able to taper off. None of my patients are "stuck" on Buprenorphine. This is a myth spread by people who don't want to stop using opioids, to justify their continued use... If it was easier to get off heroin than buprenorphine, why are you on buprenorphine? Because you couldn't stop using heroin. My patients start buprenorphine after trying to stop using opioids hundreds of times...failing over and over again to control it. They are desperate, losing hope, scared that the opioids are going to kill them, and many times have already lost everything they love. Good luck! :)

[@GlobalConstructionLLC]

No withdrawls?

[@dr.grahamchelius9087]

That is the goal... however they started a very low dose that is difficult to reproduce here in the US...they started with 0.2 mg and the smallest size we have easily available is 2 mg but you can get belbuca film as small as 0.075 but they are expensive and hard to get...

[@GlobalConstructionLLC]

@@dr.grahamchelius9087 👍I've been able to cut ,25mg. with the film and a very accurate medical plastic ruler... does a week on this fractional dose seem excessive, and would 8 mg. be alright for a target if you're just trying to get off? Thanks for your time with this

[@dr.grahamchelius9087]

@@GlobalConstructionLLC Sorry about the delay in getting back, I like a high target dose initially, like 16 mg, it helps better reduce craving, and it takes longer to get out of the system which reduces relapse risk...hopefully the motivation returns before the Buprenorphine wears off completely...then ENGAGE in Recovery for 3-6 months before beginning to tapering off, that way skills are gained that will be needed to prevent relapse...

[@GlobalConstructionLLC]

@@dr.grahamchelius9087 No apologies needed, you're a busy man! Cutting the film with a razor seems to be the most accurate way...My friend is up to 1.5 mg x 4/day...---6 mg/day and probably going to 8mg... should he just stop the original agonist (H)?

[@dr.grahamchelius9087]

@@GlobalConstructionLLC The Swiss folks targeted a 16 mg dose before stopping...other opioids...

[@BishSmish-jn6cx]

Giving it a shot in the morrow

[@dr.grahamchelius9087]

Let me know how it goes, if you have trouble watch my "having trouble getting started on suboxone from fentanyl" video kzbin.info/www/bejne/opm5c6qNabuSY9Usi=QQFiAyeR_UISv_EP

[@urpalamericanal9525]

Man I been wondering y this has been back firing...I just need a little more Insite

[@dr.grahamchelius9087]

Staying on the same dose of the usual opioid the whole time the buprenorphine is being increased is the key to success

[@Danielle-zy7un]

1 second ago So has this been my problem I was told by day 7 I’m on 16mg which I got and was ok. But when I was told to stop fet on day 7 I could feel the fetty withdrawal and here I was on subs and using fetty. Should I be trying to smoke less I was using my usual amount a gram day. NOT only using when I feel icky was this my problem? I want to be done so bad but I have a job young kids no one knows I can’t go anywhere or be sick but I want to be done!

[@nickolashampton1903]

I have heard bup/naloxone 8/2 still causes precipitation and to get something without the naloxone in it...is this true do you know? Cuz I have the bup/naloxone and could start...but have been affraid because it’s definitely fet. Being used...

[@dr.grahamchelius9087]

If you can find the 2 mg tabs or films and cut to 1/4 or less (0.5 mg or less) for a couple days, then slowly double the dose every day...0.5 mg a day for 2 days, then 1mg a day, then 2 mg, then 4 mg, then 8 mg, then 16 mg a day...that works very well for most people...stop using once at 16 mg or more...the naloxone should not cause you any trouble, just spit your saliva out after letting the dose dissolve for 30 minutes each day...sometimes when people swallow their spit after the dose they get sick, but after several days that problem tends to resolve, so then you can spit it out or swallow AFTER the 30 minutes to dissolve...

[@danielwoods7490]

Just make sure UV not used in over 12 hours or so, the further into withdrawal th better it works an th more relief up get I used them to break a ten plusbyear habbit,bbest or luck man

[@PatriciaAngona]

Subs are more painful then getting off of heroin

[@dr.grahamchelius9087]

transitioning from methadone or fentanyl to buprenorphine can be difficult. Careful microdosing is a proven method.

[@nancymarkey-miller1020]

I lived in Hawaii from 1987 to 1991 and would give my life to be back there. My problem started with prescription oxycodone from a broken back and then my doctor closed her office and gave me a taper long story short I've ended up on what I thought was H but I'm sure has elicit f in it. I have microdosed up to 4 mg twice a day for 2 days now and decreased use to 0.25 to maybe. 5 a day. According to the Bernese schedule I should take 12 mg in the morning and completely stop everything else. I think I'm going to do 8 mg and see how I feel and if I have any withdrawal symptoms take another 4 mg. At this point I have had no withdrawal at all I think due to the fact that I tried Bernice about a week before and had gotten up to that 8 mg dose so I'm sure I had residual bupin my system. I talked to my doctor here about microdosing and he had heard of it told me to give it a try and let him know what my appointment how it goes. I have never needed more than 8 mg of Suboxone a day to maintain. So I guess tomorrow is the 8 mg in the morning wait 2 hours and if I have any withdrawals take another 4 mg. In your opinion is that reasonable? God I wish I was back in hawaii! Just to know one of my problems is I have no insurance so detox are going somewhere isn't an option plus I just got laid off from my job about 2 months ago and I have to get back to work. Everything I do requires a drug test! I am going to do this if it kills me. Any input would be appreciated.

[@dr.grahamchelius9087]

Well Aloha then! It sounds like you are on track. A couple reminders: DO not reduce your usual opioid dose until at the final target dose of Buprenorphine when microdosing. Also Fentanyl is extremely potent, so many people require way more buprenorphine initially than they may have needed in the past, often 24 to 32 mg a day for the first several days to control withdrawal. Then you can reduce to a reasonable maintenance dose. I usually prefer that my patients take 16 mg a day of buprenorphine. It is strong enough to control pain and withdrawal better than lower doses, and substantially blocks the mu receptor so relapse results in less effect. Finally, you still can increase the dose to 3 a day (24 mg a day) if you hurt yourself or whatever, so it gives some flexibility.

[@nancymarkey-miller1020]

@@dr.grahamchelius9087 so if I take my second dose of 4 mg this afternoon which will be two days in a row of 4 mg bid I can take 8 mg in the morning then say 2 hours later take another 4 mg if I feel like I need it? I'm trying so hard to do this right! I can't believe I'm in this position. I went through a very unexpected divorce after 30 years of marriage I lost my father when I was 12 it was a Navy pilot and within 6 months time I lost my marriage my mother passed away and my best friend and cousin drowned on his 47th birthday which was all within 6 months of each other. Losing my pain control doctor was the Tipping of the iceberg but I know I can reverse this! Thank you so much for responding and I hope you don't mind if I message again with questions. By the way I don't know where you are I lived in Kailua loved it and would kill to come back!

[@nancymarkey-miller1020]

@@dr.grahamchelius9087 I have already reduced my dose I didn't know I was supposed to I've gone from about a gram a day to 25 to. 5 a day. Also, I do not inject! What I'm wondering is since I know now the synthetic forms store in the adipose tissue do you run the Whisk of withdrawal as they release from your fat cells? I know that metabolites can stay for quite a while but did not know if the release of those metabolites into your system could cause withdrawal. I really wish we could talk on the phone but I'm sure I can't afford your rates LOL that's another one of my problems. I probably would have gone to an all-out week detox but I have absolutely no medical insurance and right now the doctor's visit plus prescription is costing me $330 a month. Hopefully I'll get through this back to work and life will be back on track. Thank you so much for the response you have no idea how it has lifted my spirits and given me hope and inspiration.

[@dr.grahamchelius9087]

@@nancymarkey-miller1020 I usually have my patients double the daily dose every 48-72 hours... so 0.5mg, then 1,2,4,8,16...

[@nancymarkey-miller1020]

@@dr.grahamchelius9087 okay then I will do 8 mg tomorrow and see how it goes. Since I have been fortunate to have no withdrawal I'm sure because I had Suboxone built up in my system from my first attempt if I'm good after 2 hours I should be good right? I'm sorry to have so many questions but absolutely no doctors on the mainland have any information. When I spoke to my doctor he had heard of microdosing told me to give it a try and let him know how it goes. He couldn't understand why I had PWD after 36 hours of abstinence in a negative drug test. I know now because of the metabolites. I guess in the long run the best thing is to just listen to my body and reach for a small dose of sub if I need relief before I reach for the other. Thank you so much! You are definitely a blessing to the residents of hawaii. If I ever get back there which I'm hell bent I'm doing I'll be sure to look you up! Thank you so much!

[@andreashare8686]

Do you have an email Dr ? I could email you questions about microdosing

[@dr.grahamchelius9087]

[e-mail]

[@Neverasheep]

Be careful when selecting a doctor. Too many sub doctors see you as a life long paycheck that they never want to lose. I was on it for 10 years, had to taper on my own and finally jumped off.

[@dr.grahamchelius9087]

This had not been my experience...but maybe things are different in Hawaii...I strongly encourage my patients to taper, when they are ready...see my "how to get off suboxone" and " I hope something shitty happens to you" videos, also see my other response from today,

[@Neverasheep]

@@dr.grahamchelius9087 then your one of the good ones. I had to taper on my own after 10 years. Every time I brought it up they quickly discouraged it and said I needed to stay on it for life. While on subs I had several side effects that had my worried. I’m on day 60 today with only minor WD’s for the first few weeks. Luckily I’ve avoided PAWS so far. No anxiety, depression or even tears. I really think lions mane has really helped my brain function recover.

[@dr.grahamchelius9087]

@@Neverasheep Congrats and good luck, maintaining a high degree of self evaluation will keep you making progress and avoid relapse, watch my "keep your eye on the fire" video

[@TheMatrixgod]

@@Neverasheep what was your side effects?

[@Neverasheep]

@@TheMatrixgod my testosterone was destroyed and I’m still dealing with some major chronic stomach issues. I’ve been off now for 584 days.

[@adambarnsdale2784]

i was using everyday fetynyl and i started on 6mgs suboxone 24 hrs after 2 days doing a half point and days before was more like 2 points a day but im on 6 for 7 days and im back to sleep and no cold sweats, suboxone is definately for those who want to quit quick and stay off drugs, im a way better person on suboxone then methadone. no anxiety and its just less of a drug like methadone i say is a drug i dont like the buzz but need to feel one or you will feel sick off opiods. vicious cycle im 36 been using since 2005 with 4 years clean in 2 stints. but i was anchious mess ona low dose of methadone for years.

[@dr.grahamchelius9087]

Good work! Great to hear you are doing well.

[@justaguy4real]

4:00 shiznit i literally sat in hot shower wanting and considering murdering myself to bleed out, for agonizing hours. Def suicidal....

[@dr.grahamchelius9087]

Get someplace safe, or call the suicide hotline right now 988, or text 988

[@dr.grahamchelius9087]

I have been telling the following to my patients who are feeling hopeless: First, let’s define chemical dependency like this: Chemical dependency is a brain disorder where a person will continue to use a substance despite knowing that is will have negative consequences. Also, just like some people have a brain disorder that causes them to hear voices and they can’t just decide to shut it off, people with chemical dependency have a brain disorder that causes a persistent and overwhelming desire to use a substance that they can’t just shut off…. But it can be managed with treatment. This is important to understand because if you or people around you think that you should just be able to shut it off, then when you can’t you feel like a failure, or others judge you as one… You are not a failure if you can’t just wish chemical dependency away, you are normal. You need help, help is available and it works.

[@ArizonaJonsFromTucson]

9😊m

[@dr.grahamchelius9087]

translation please... :)

[@MichaelSantos-wk3rx]

How can I message you

[@dr.grahamchelius9087]

I have to be careful that I don't actually "treat" patients over the internet. I can give general information.

[@MichaelSantos-wk3rx]

Understandable I just don’t understand how to get started. So do I start at anytime during day with no time Timelapse. Like the .05 of sub can be taken at anytime. For instance if I just got done smoking some fent and Im well now,can I start the first day of microdosing

[@dr.grahamchelius9087]

@@MichaelSantos-wk3rx Yes, people can start the Bernese microdosing method at any time, they don't need to be in withdrawal. More recently people have been trying a rapid micro-dosing technique where they are taking 0.5 mg (1/4 of a 2 mg tab) under the tongue every 1-2 hours, and very quickly transitioning to Bus from fentanyl...