I consider my pharmacological knowledge to be both deep and broad, although let it be said that a horse has four legs but still can trip. I have found that the doses used around the world for addiction are far too high, as buprenorphine is a very strong drug and one milligramme thereof is equivalent to a half-grain (thirty milligrammes) of morphine over twice the duration. It seems that nearly everybody in the United States of America that has a mild-to-moderate hop-habit receives sixteen milligrammes, a dose equivalent to eight grains (480 mg.) of morphine. The average 100 mg. stamp bag is thirty per cent. pure, and so it contains thirty mg. of morphine; this can be multiplied by four, since morphine by injection is four times as potent, and we arrive at two grains of oral morphine equivalent.
If we accept as true that an addict uses the entire stamp-bag at once, the number of times he doses can be multiplied by four to get the right dose.
For pain, the dose is rather lower, but not as low as Reckitt says it should be. The doses for pain according to Reckitt are 200 Âµg. (microgrammes) and 400 Âµg., but these are woefully inadequate for very strong pain. For a migraine, they would work quite admirably; but I think that doses of one, two, and four milligrammes could also be indicated for stronger pain, especially cancer pain. The dosing frequency is also different, as one must dose two to four times per day rather than the once only indicated for addiction-only therapy. The different frequency applies whether the patient has a habit or no; as long as a patient has pain, he must receive two to four doses per day, regardless of any habit or addiction. The dose in addiction must, of course, be greater for reasons of tolerance.
My own personal dose is sixteen mgm. per day, although my doctor does not know the appropriate pain dose of Subutex and is making a guess as per what I report, which always seems to be, "I have pain, give me more," even though my pain disappeared at eight mgm. per day and the other eight goes into my bedside drawer stash
I find it sad that my doctor in the UK must prescribe the addiction formulation of buprenorphine (Subutex) rather than the pain formulation (Temgesic) even though the prescription states "for pain". Although let it be said that I did give my grandmother, a woman accustomed to low-dose morphine only, a 4-mg. dose of Subutex under the tongue and she overdosed enough to nod out.
How much does everyone else take? Both pain and addiction uses are good to know.