[anonone17]

Hey everyone, I have not posted here in a while. About a year and a half ago I used to frequently be on here asking questions and furthering my knowledge. For those who do not know me, I am a pharmacist and am in my late 20's. To be completely honest, I am not a very experienced one only being out of school and employed for about two years now. I stopped posting because I had recently gotten married and had a child which has consumed almost all of my time outside of work.

Anyway, I have always been fasinated with chemicals (which led me to become a pharm in the first place) and especially addiction which I try to study on my free time. I have lost many friends and family to addiction especially heroin and opiates.

The reason why I began to post here again is because about a month ago, I realized I had never done any research into Suboxone addiction and have been casually looking around here reading people's experiences. What is so fasinating to me is that because I already know how drugs interact with a person's body, I like to find out how they correspond with a person's mind.

So lately I have been reading about how people have been having such a hard time getting off of suboxone. I can understand this seeing as the drug is nearly 60 times as potent as morphine. My professional opinion is that there was not adequate research done on the long term effects of using suboxone when the drug was released. I have had so many people come through picking up a sub script and when I saw they were taking a lower dose and I asked them how they taper was going they said " horrible, my doctor never told me about the excruciating pain off getting off ". I truly believe that many doctors misinform or " trick " their patients into believing that suboxone is a miracle drug that will solve all of their problems. Yeah, maybe if you have good insurance and can afford to be on it for ever. Not so much if you one of the many " average " people that I see on a regular basis who beg me for just a few pills because they lost their job which covered them for scripts and now they can't afford to get their 16mg's a day to which they are prescribed. What can I say? I am just outraged that some doctors will have no problem prescribing doses of this drug equivilent to over a gram of morphine per day and then just let the patient suffer when it's time to get off. I don't know if anyone reading this is aware but the ceiling dose of buprenorphine is 3-5 milligrams. Anything above that simply serves to build up a patients tolerance so that no matter now much heroin or any other opiate they take, they're tolerance prevents them from feeling it. I feel this is a classic example of somthing that looks great in a lab setting but has a lot of problems in the real world.

Sorry for the long intro, I just wanted everyone to understand what prompted me to write this. So after knowing all of this, I began to talk to some people that come through my pharmacy with sub scripts. I have identified a few of them who are in the process of tapering off. My experience is that most of them taper MUCH TOO FAST, MUCH TOO QUICKLY! They are astounded when I say "If you were taking 600 mg of morphine per day and then dropped it to 300 mg, would you expect to feel fine?" Of course they say NO! and then I tell them they have to taper much more slowly because this is such a potent drug. In hospitals, the dose given for pain relief is 50 micrograms! Thats 0.05 mg!

So I have been keeping track of these people, trying to give them my best advice and yesterday I was talking to an 18 year old boy who comes in and is in the process of getting off.

He began taking 16mg's a day about 1 year and a half ago. He remained on that dose for 1 year. Then six months ago he made the decision that he could not live his life that way forever and decided he had to get off sooner or later. Now what I am about to type is going to be very controversial and I cannot even explain it myself which is why I am hoping maybe some of you guys can help me.

He tapered with this schedule and told me that the very worst w/d he ever had at any point during the taper was a slight body ache and feeling like he had a mild cold. He said it was in no way comparible to heroin w/d:

16mg to 8mg- He stayed on 8mg for one month
8mg to 4 mg- one month
4mg to 2 mg- one month
2mg to 1mg- 2 weeks
1mg to .5mg- 2 weeks
.5mg to .25 mg- 1 week ( this was accomplished by taking a quarter of a 2mg pill every other day.)
.25mg to .125mg- 1 week ( this was accomplished by taking a quarter of a 2mg pill once every 4 days.)
After that, He came off!

Note that this was a 50% reduction in dose each time. It takes approx 3 days for the plasma level in your body to level out for a dose change. ( hence why it take a few days for w/d to set in )

Here's the interesting part: I asked him, me being shocked, if he ever met anyone else on Sub. He said no because most people his age were not heroin addicts. This led me to believe that a large part of the w/d from suboxone is mental or " in your head ". I know this cannot be proven but this boy told me he never worried about the w/d and that made me think maybe that made it a lot easier? Remember he said it was virtually painless and the very worst was having a feeling of a slight cold, but was completely bearable. He said he was in a very good mood throughout because he was excited to be " entirely clean " He said that the feeling he got from his own willpower of being able to taper down and get off all on his own kept the w/d from bothering him at all!

So my point here is this :
1. I do not know medically how this is possible seeing as so many people on here say the w/d is worse than heroin.

2. This boy was about 5'-7" and 140lbs and said he had a fast metabolism so maybe this contributed to the easy w/d? I know that most people who even taper 1mg at a time have bad w/d's so I am dumbfounded here how he could do a 50% reduction and be fine.

3. This has really caused me to believe that if you don't worry yourself about the w/d it won't be as bad.

Thanks for reading and any experience getting off sub would be great! I look forward to reading your responses!

[anonone17]

Isn't there anyone out there who has experience with getting off sub? I'd love to hear it.

[Robert_325]

Originally Posted by anonone17

Isn't there anyone out there who has experience with getting off sub? I'd love to hear it.

A 50% dose reduction at one time is too much for the majority of people. Most people would have w/d problems doing that. Patients should also do a process of skipping days at the end for the best results. At least that's my experience.

There are sub threads all over the forum. Read around and you'll see how others do it. Here is how I used subs and what I recommend on the forum. God bless.

http://www.drugs.com/forum/featured-...apy-50887.html

[witch_md]

Tapering as above does seem a little fast. I'm an Addictions trained physician. The ABSOLUTELY fastest I tell someone to decrease is by about 2mg every 2 weeks. Then at the end the last 2 mg ( or a 2 mg tablet split in half, the do make a 2/.5 tablet also) every other day for two weeks, then every third day for two to 3 weeks. This program is almost always succesful.
I tell people Suboxone is expected to be a 6 to 9 month program, they can be on it for longer. NOT a quick fix.

3 reasons people are comonly unsuccesful at tapering:

Not dealt with psychological reasions they were using.

Thyroid levels are off-more common in women

Testosterone is off-more common in men

Baseline mood disorder, depression, etc. Suboxone increases dopamine. Just like the other opiates. But so do a lot of other medications. Go talk to a primary care doctor or someone who is REALLY skilled at this stuff. Not every one who can write a prescription is a good doc.

And the original writer is incorrect. The correct dosing of Suboxone is in fact 16mg per day. Give or take. Max is 32. Your Receptors ore 97% full at 16mg a day so going above this is pretty pointless. Occationally we see a slower metabolizer who did a ton of opiates but only needed 4 mg or so of Suboxone to not crave. Otherwise slow metabolozers get "goofy" dysphoric. Go bact to Goodwin and Gilman my friend. Or down to your local methadone clinic and get some practical experience. Not everything is black and white. Lots and lots of grey out here.

[Robert_325]

Originally Posted by witch_md

Tapering as above does seem a little fast. I'm an Addictions trained physician. The ABSOLUTELY fastest I tell someone to decrease is by about 2mg every 2 weeks. Then at the end the last 2 mg ( or a 2 mg tablet split in half, the do make a 2/.5 tablet also) every other day for two weeks, then every third day for two to 3 weeks. This program is almost always succesful.
I tell people Suboxone is expected to be a 6 to 9 month program, they can be on it for longer. NOT a quick fix............................................... ...................................

Go talk to a primary care doctor or someone who is REALLY skilled at this stuff. Not every one who can write a prescription is a good doc.

And the original writer is incorrect. The correct dosing of Suboxone is in fact 16mg per day. Give or take. Max is 32. Your Receptors ore 97% full at 16mg a day so going above this is pretty pointless. Occationally we see a slower metabolizer who did a ton of opiates but only needed 4 mg or so of Suboxone to not crave. Otherwise slow metabolozers get "goofy" dysphoric. Go bact to Goodwin and Gilman my friend. Or down to your local methadone clinic and get some practical experience. Not everything is black and white. Lots and lots of grey out here.

POO POO KAA KAA!!!! What a bunch of garbage ... this is exactly what the drug reps tell you doctors. 16 - 32mg ????? GIVE ME A BREAK DOC!

This is exactly why so many people are in trouble with this medication. It's because of instructions like this. Reducing 2mg every two weeks is WRONG. You should try reducing the dose based on a % of what your patient's current dose is and based on what your patient's symptoms are. Buprenorphine is NOT a med where one standard rule applies to everyone. Drs don't give suboxone dosing instructions based on a patient's symptoms but rather like the 2mg every two weeks as you said. That's why so many people here are sick getting off this stuff.

Being on suboxone for 6-9 months will give you a bunch of people addicted to suboxone instead of percocets or hydrocodone. That accomplishes nothing. Talk to some people who have successfully used subs rather than the drug reps who are trying to sell as much medication as possible. This is a situation where the patients who have been successful using subs know better than the drs who are responsible for getting people strung out.

The science of receptors and such is not that complicated. You don't need to use suboxone for any 6-9 months. Suboxone isn't a cure, it's ONLY for helping someone to stop using opiates. It should be used short term for detox and hardly ever any longer than 60 days. If a patient hasn't committed to stop using opiates by then they're going to relapse anyway. 60 days gives them plenty of time to get into recovery or whatever lifestyle changes they are going to make.

[melinda7.5]

Originally Posted by witch_md

Tapering as above does seem a little fast. I'm an Addictions trained physician. The ABSOLUTELY fastest I tell someone to decrease is by about 2mg every 2 weeks. Then at the end the last 2 mg ( or a 2 mg tablet split in half, the do make a 2/.5 tablet also) every other day for two weeks, then every third day for two to 3 weeks. This program is almost always succesful.
I tell people Suboxone is expected to be a 6 to 9 month program, they can be on it for longer. NOT a quick fix.

3 reasons people are comonly unsuccesful at tapering:

Not dealt with psychological reasions they were using.

Thyroid levels are off-more common in women

Testosterone is off-more common in men

Baseline mood disorder, depression, etc. Suboxone increases dopamine. Just like the other opiates. But so do a lot of other medications. Go talk to a primary care doctor or someone who is REALLY skilled at this stuff. Not every one who can write a prescription is a good doc.

And the original writer is incorrect. The correct dosing of Suboxone is in fact 16mg per day. Give or take. Max is 32. Your Receptors ore 97% full at 16mg a day so going above this is pretty pointless. Occationally we see a slower metabolizer who did a ton of opiates but only needed 4 mg or so of Suboxone to not crave. Otherwise slow metabolozers get "goofy" dysphoric. Go bact to Goodwin and Gilman my friend. Or down to your local methadone clinic and get some practical experience. Not everything is black and white. Lots and lots of grey out here.

witch_md

I think about 99.9% of the people on this board will disagree !!!
The biggest reason we are on this forum is because of people like you.
Most people come here after seeing witch_md's...
I have seen people that have been on Suboxone after nine months or longer and they have one HEL of a time getting off.
We pretty much have figured out why you want us on the subs so long.
Kind of like when are drug dealers don't want us to get clean.
I think I would take my chances with staying on them short term and the lowest possible dose.

[anonone17]

Hey thanks a lot guys for posting! And yeah Robert, I kind of suspected she was a Dr. when she said " 16 MG is the CORRECT dose. " Last time I checked there was never any correct dose for more than one person when it relates to stuff like addiction. I thought that the Dr.'s treated the patients on a " individual case " basis? Guess not. Anyway, what I have really been trying to figure out on here is this: have you, Robert, or anyone else reading this had yourself or known anyone who was able to get off of suboxone in a fashion similar to what I listed above without horrible W/D's? The reason I am asking is because I still cannot figure out how this was done.

After doing extensive reading on here especially of people experiences getting off, I do here the occasional " yeah sub w/d was no problem for me " story, but I am wondering if anyone could tell me what factors may have contributed to these people being able to taper down rather quickly and have such mild w/d?

By the way, I happened to see this young man again today and asked him what kind of lifestyle he lived. He said that he runs almost daily at least a mile a day and had done that throughout the tapering process as well. He said the exercise made him forget about the w/d's entirely and that made it even easier. He also said that he was about 8-9% body fat.

I am thinking that maybe this may have contributed to why he had such an easy time getting off? Do any of you guys think that maybe since he had low body fat, that less bupe was stored in his body, therefore keeping the w/d's shorter than average? Add that to the fact that he was exercising fairly heavily throughout the process which helped to burn even more fat and possibly speed up the elimination process further? I honestly do not know if any of this would make a difference seeing as I have never been on, or w/d'ed from bupe so I'm asking if you guys think it's possible.

Any experiences you have had at all would be greatly appriciated! I am just finding that cold hard facts about the bupe withdrawl process are hard to come by and I can use all the real-world info I can get so maybe this will help me to figure out why some people have agonizing w/d's " worse than heroin ", and for some it's cake.

Also, Robert I read on one of the tapering threads you posted on that a patient can " cut his dose by 25% and maintain that for 4 days and if no w/d symptoms are felt, then it would be safe to taper another 25% " Just wanted to ask does that mean if a patient were taking say 2 mg's and they tapered to 1.5mg and held it for 4 days, felt nothing, they could most likely safely taper down to 1mg? I just do not understand why some people must taper down and maintain that about for say, two weeks before tapering again, but yet some can do it every four days?

Thanks again everyone for all your help!

[Robert_325]

It's definitely a critical factor when patients exercise diligently while tapering. I always harp on exercise, it's the best opiate detox med there is. I'm not so sure about the low body fat, but the exercise helps with natural endorphine production and that helps with our overall well being.

Everyone is a little different as far as tapering successfully goes. Most people CAN'T make it with reducing their dose by 50% like the example you gave. Like I said, exercise probably helped that person as well as some other individual body functions. I think it's basically impossible to say much beyond that with what information we have available.

This person really took longer being on subs than the way I suggest using them. The only thing he did successfully that is a little surprising was the 50% reduction when he did make drops in his dose. Starting out at 8mg he would have finished the taper in eight weeks doing the taper the way I suggest.

I used opiates for over 35 years. I came up with the process that I recommend here when I used subs myself. It worked for me without incident. Since I started posting on this forum I've had LOTS of people use subs and taper off successfully. It's the exception when we have problems.

Tapering 25% every four days usually works just fine. But as the dose goes down so does the amount you taper by. It would go like from 8mg, to 6mg, to 4.5mg, to 3.375mg, etc. You simply take the current dose and multiply it times .75 and that will give you the next dose in the taper. Hope that helps. God bless.

[intelmetal]

Anonone17, I have been abusing opiates for the past 11 years, started w/ hydros, norcos, oxycodone, roxies, and finally METHADONE, LOTS OF METHADONE !!! I,m talking about 360mg per day for at least a year straight. That's nine 40mg wafers a day ! I would take 120mg am, 120mg noon, 120mg evening. The 1st 4 years of my addiction was to the regular short life stuff. Then I got tired of always chasing down pills and was told about this wonderful drug called methadone I had no idea what it was but I tried it and it worked for 24 hours straight. I thought I had solved my problem, no more popping pills every 4-6 hours, no more chasing all sorts of opiates from different sources, buying in bulk ( heck, it was so much cheaper and convenient ) . Boy was I wrong ! I did not realize it until it was to late and I was raising my dose weekly. I reached 360mg within 1 year ( my 5th year on opiates ), at that moment I knew I was in trouble, so I started to taper over the next 5 years or so. I took my last dose ( 20mgs ) of methadone on May 2nd, 2009 then saw doctor on May 4th, 2009. Was told to take 16mg per day, which I rejected. I told my doctor that I would not take any more than 8mg a day. Got script for 15 8mg subs and have only gone through 13 of them to date. Now lets go back 2 weeks, 2 days ago, my 2nd appt. w/ doctor was May 18, 2009, I went and said everything was going well, little did she know I was tapering and was already down to 2.5mg. Anyway, got another script for 30 8mg subs ( 1month supply ) LOL ! and as of today I have still not opened the stapled package w/ receipt attached to bag - bottle is still in bag w/ 30 8mg subs, I won't even open it for another week. My point is most doctors have no earthly idea as to the proper way to induct or what amount to prescribe their patients !!! I am tempted to not even go to my next appt., which is about 2 weeks away. At the rate I am tapering, I will not even use a fraction of my bottle of 30 that I have not opened. You see, this is not a drug that should be used long term, EVER ! I am now at 1mg per day and still tapering. With 256mg left over, get it? I would have to be a complete idiot to buy more, listen to doctors, listen to drug companies, etc. What am I to do with all this extra medication that I will have laying around ? I will probably flush it down the toilet. That a lot of money wasted on being over prescribed in the 1st place. Remember what I said earlier, that my doctor wanted to do 16mg per day. That is criminal ! In closing, it is not easy to get off subs, especially if you were on a long acting opiate such as methadone, unlucky me. But it can and is being done by brave people everyday. It is a thankless sacrifice we endure daily 24/7, but we are the survivors and will prevail. SAY NO TO DRUGS !!!!!!!
IWANTOUT

to live my life and to be free !

[Dnote33]

Hi I have been on subs now for about 2 years. I started out taking about 16+ mg a day. After a few months i was taking only 2mg. I had to go to the doc every 2 weeks to get a new script. Once i had tappered down to 2mg a day he assumed i was good and cut me off. I started getting really bad hot/cold flashes so I had to buy more subs on the street. This means i have to keep talking to all my old friends so that i have a place to get my meds. If you are trying to quit, talking to your old friends is probably the WORST thing you could do. You go pick up your meds and see them sitting there doing your favorite thing. Its nearly impossible to stay clean this way. I have relapsed about 5 times within these 2 years. When i relapsed i had to take about 3x as much subs to stay well. At the moment i need about 4mg a day. 2mg in the morning and 2mg during the day when i start feeling w/d symptoms. If i do not take any subs i start overheating, i get the chills and can not sleep. These hot/cold flashes are different from heroin ones. I know A LOT of people who have got off using subs and a lot(like myself) who struggle every day with it. One of my friends actually used working out as his suboxone. I have to agree fully that at least 50% of the withdrawls are mental(with subs) I want so much to not think about withdrawls but i know all too well how much it hurts. Getting off optiates is no easy task. It takes dedication, hard work, and determination. Above all, the USER has to WANT to be clean. If the will is not there no amount of medication will help. There is no easy way out of heroin/opiate addiction and nothing is harder on this earth to do than get off opiates after years of use. Please pray for me. I need all the help i can get.