Ida Bigge Hit: What are your problems?
I have been on Subutex for about six months now. I was initially taking my dose under my tongue, like they say to, however in the past few months I have really gotten into injecting it. Around the place I inject I have noticed a hard lump. What is this? Also a couple of times after I’ve injected bupe, I’ve had a massive headache and have been a bit shaky... In a few weeks my clinic is changing everyone on Subutex over to Suboxone. How will this affect me?
Dear Bupe Boy
Both Subutex and Suboxone are intended as sublingually administered drugs. This means they were made to be dissolved under your tongue. This said, many people still inject both Subutex and Suboxone. One of the problems associated with injecting either Subutex or Suboxone, is that these tablets (like other tablets) contain binders and fillers, often with substances such as cornflower or talc, to bind them together, so it is really important to filter out these substances. The best way to filter any pill intended for injection is with a wheel filters (also known as a pill filter). Wheel filters will remove particles which are too small to be filtered through cotton wool. Some wheel filters even have the ability to filter out bacteria. Filtering bacteria is especially important if the bupe you’re injecting has ever been in your mouth. The human mouth is one of the most bacteria heavy places in the human body and by injecting bupe which has been in your mouth (without properly filtering it), you are introducing bacteria directly into the body, bypassing the body’s natural defense systems. This can result in a “dirty shot”, which can make you very sick. This may explain why after injecting bupe you sometimes have a banging headache and feel a bit shaky.
Another reason why you may feel shaky after injecting bupe is that one of the pharmacological effects of bupe is to attach to the body opioid receptors and to evict any other opioids which are also attached to the receptor. When this happens the body goes into a withdrawal state called “precipitated withdrawal”. If you are only using bupe, this won’t be an issue, however if you are using any other opioid substance, you need to wait until you go into “active withdrawal” (when you feel really sick), before either dosing or injecting bupe. The length of time this takes depends on what opioid you’ve taken; as little as four to six hours for heroin or over 24 hours for methadone (other opioids are in between).
Many pharmocotherapy clinics have begun to dose with Suboxone rather than Subutex. This is because Suboxone is seen as a deterrent to injecting as it naloxone together with the buprenorphine in the same tablet. (Subutex only contains buprenorphine.) Naloxone is the drug which is administered to people who have overdosed on opioids. Naloxone works by very quickly reversing the effects of opioids. Naloxone is only effective if injected, not if taken under the tongue. If you have any opioids in your system before you inject Suboxone, the naloxone will reverse the effects of these opioids and will make you feel very unwell. However, if you have only been injecting Suboxone and haven’t been injecting any opioids, you are highly unlikely to feel any discernible ill effect from injecting Suboxone and it will be just the same as injecting Subutex. However, it is hoped that people will be able to get more take-aways with Suboxone than with Subutex eventually, as it has a low overdose risk and a low sell-on (diversion) risk.
As for the lump in your arm, if there is any swelling or redness, or sensitivity to the touch, you may have an injecting related abscess. Abscesses can develop when bacteria is introduced into the body or when a mixture is not filtered properly and foreign particles remain in the body. To avoid developing abscesses or any injecting related infections, remember to swab before injecting, always use a new sharp to inject with, filter any pills with a wheel filter and change your injecting site every time you inject. You will need antibiotics to treat an abscess and it is important not to inject into or near the abscess until it has fully healed. In
If you need more information, contact NUAA on 1800 644 413 or (02) 8354 7351.
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