Coming off Subutex - what am I in for?

[Johny2]

Hey, all. Thanks in advance for any help / advice.

I have been on Subutex for 10 years now. After a poly drug addiction culminated in a road to disaster via pain pills.

I have been clean of other drugs and I have tapered off once around 8 years ago. At which time the ‘harm reduction’ specialist I was seeing who was supplying the recovery service advised after tapering down to 0.4mg I would be fine stopping all together. Saying other people had done the same.

In reality, a couple days after I stopped taking the 0.4 I felt horrendous psychologically. I felt like a scared child with anxiety and severe depression. I started taking the subs again after a torturous couple weeks trying to take ssri’s the doctor had supplied that made me feel worse. I dunno if I’m a wimp or what but either way I was so far from being able to handle the psychological withdrawal.

Fast forward 8 years and I have tapered down very slowly again to 0.4mg. I am being pressured to stop taking the stuff again, I also want to be free of it myself, but I’m in a high pressure job where performance is essential and I feel I need to be able to find a time where I can a couple weeks off work at least (which I have been trying to facilitate for over a year and it never seems to be able to happen). I also have a daughter who I look after 3 days a week which adds to my concerns. I am being advised to just stop taking the subs and ride out the discomfort by keeping busy.

I feel I am in a better place now psychologically but I fear I am facing another pretty horrendous ride with the time comes.

Yet again I’m getting the old “don’t worry you’ll hardly feel it, you’re in a better place now. 0,4 is nothing. It won’t even be doing anything” from the harm reduction guys but I can’t help but feel this is overly optimistic!

From those in the know, what am I facing? Any advice on a strategy to get clear of this once and for all would be greatly appreciated!

Thanks!

 

[EvidenceOfTheResurrection]

I understand all you wrote. Appreciated. How’s it going now? Is the 0.4mg the total for the day, or each dose? Bupe has a weird effect-versus-dose profile. Low doses are not meaningless. And even professionals usually do not understand that. And there is a ceiling effect - which professionals DO understand. I also got stuck on low doses and people didnt get it. And yeah I tried quitting cold turkey once and felt like… a scared child. Exactly.

 

[Johny2]

I am still in the same situation. I had an appointment with the recovery service provider yesterday and they just told me they didn’t need to see me and refilled the script. Which is odd as two weeks ago they were pressing me very hard to stop.

I have seen a ‘specialist’ prescriber at the centre previously who claims to have worked at a drug company who manufactured bupe. He claims to know the drug very well and showed me various charts. He thinks my 0.4 mg dose is effectively doing nothing.

I take it once per day.

He thinks it’s not enough to have any effect and so is effectively wearing off soon after I take it and so I am effectively free of any withdrawal symptoms and could just stop taking it and not feel bad at all.

To support this, when I have a urine drug test it sometimes shows negative for bupe.

However, there is another worker there who has recently moved from a big city (I am in a small town) and he has much more experience than anyone else there it seems. After talking to him, he claims that usually from 0.4 per day (for a long time) to nothing, the user can expect a couple of weeks discomfort and will then start to feel better.

The information is very mixed. And I know of other people who have been able to stop from 2mg.

I am coming to the conclusion that everyone is different and that I am perhaps a bit of a wimp when it comes to withdrawal symptoms!

 

[MuertaMan]

I survived the withdrawal from 7 years on bupe (Im back on it now but was clean from it for 5 years) was taking around 6mg snorted a day and all I can say is lyrica and xanax can help if you can get ahold of them and don't expect to sleep much unfortunately. I literally didn't sleep for a month because of the RLS/restless body shit and cried alot and just couldnt get comfortable, surprisingly I didn't have any diarrhea and remained constipated that whole month it was weird. I felt bad and thought it would never end but eventually it did and I started to sleep an hour at a time and it got better and better, 6 months I would probably 70% better and by a year I was myself again. Im back on it all these years later from relapsing and going off the rails but Ive only been on it 8 months and am tapering now I want off it before a year rolls around or I fear Ill be stuck for a long time. I don't hate bupe it has its place but they definitely downplay how physically/psychologically addicting it is and I don't think that is fair or right to do to patients who may not have done their research. It does work for me though, don't even think about using opiates at all when on it, unfortunately it doesn't block the urge to use other drugs. Good luck with quitting you'll be alright, hot baths are your friend and exercise if possible it helps speed along the process.

 

[Johny2]

Thank you both for your comments.

Wow. Well done for getting off it the first time. That sounds like a drawn out recovery process. I don’t know how I’d be able to fit that length of sleep deprivation in.

I understand about the restless feelings. When I tried to come off it before that’s what I got. I never had any diarrhoea or stomach issues with bupe. All psychological and restlessness.

I sometimes get horrible restlessness now when it’s coming up to 24 hours after my last dose. Not sure if it’s psychological or not. It tends to ease if I lie down.

I had no idea I would be looking at up to 12 months to feel normal. Literally could only see my self being able to manage that if I saved up for a few years so I could afford to take an extended period off work. Not sure how I’d square that kind of scenario with family, friends and my daughter. All of whom either don’t know or don’t understand the issue. My parents advice mirrors that of the recovery program - “just stop taking the tablets”.

@MuertaMan - how did you deal with that lengthy transition period? Were you working? Socially active etc? And good luck with your next taper. Sounds like it will be easier than the last.

 

[EvidenceOfTheResurrection]

I am still in the same situation. I had an appointment with the recovery service provider yesterday and they just told me they didn’t need to see me and refilled the script. Which is odd as two weeks ago they were pressing me very hard to stop.

I have seen a ‘specialist’ prescriber at the centre previously who claims to have worked at a drug company who manufactured bupe. He claims to know the drug very well and showed me various charts. He thinks my 0.4 mg dose is effectively doing nothing.

I take it once per day.

He thinks it’s not enough to have any effect and so is effectively wearing off soon after I take it and so I am effectively free of any withdrawal symptoms and could just stop taking it and not feel bad at all.

To support this, when I have a urine drug test it sometimes shows negative for bupe.

However, there is another worker there who has recently moved from a big city (I am in a small town) and he has much more experience than anyone else there it seems. After talking to him, he claims that usually from 0.4 per day (for a long time) to nothing, the user can expect a couple of weeks discomfort and will then start to feel better.

The information is very mixed. And I know of other people who have been able to stop from 2mg.

I am coming to the conclusion that everyone is different and that I am perhaps a bit of a wimp when it comes to withdrawal symptoms!

In this case with this drug, I dont think it’s as much because everyone is different. The one claiming 0.4 is nothing is just wrong. To confirm this, you can check out a form of bupe called belbuca. The doses, taken twice a day, range from 0.075mg (yes, less than a tenth of a milligram) up to 0.9mg. If 0.4mg is “doing nothing”, then why is there a drug for pain with fda approval using doses of 0.15mg per day? Wouldnt that be a blatantly sub-therapeutic dose? Belbuca uses units of micrograms not milligrams (1000 mcg = 1 mg), 75mcg to 900mcg. The micro-dosing is for pain and the high doses are for addiction. It is a full opiate agonist at doses below 2mg per day and a semi-opiate at doses above ~4mg.

This is so counterintuitive that even “experts” cannot understand it (or even believe it). (Btw the same mechanism that causes the ceiling effect causes it to get weaker at higher doses. I can explain that mechanism to anyone interested.). Imo your best bet is to ignore experts and get your rx’s filled, throw away a portion if ness, and taper down from 0.4. If this isn’t possible I can give other opinions.. really just opinions. But you can stop thinking there must be something weird about your biochemistry or toughness or whatever.

I learned to stop arguing with anyone and just get 2mg strips and leave. One tactic for getting low doses is to fold the smallest pieces along the diagonal. The only other thing I learned is that I wished I wouldve worried about it less. Is it the end of the world if you take 0.4 and are stable? What if you made it to 0.3mg awhile?

 

[Johny2]

Thanks for your reply. I will look into Belbuca for sure. Even if it’s just to educate the workers at my recovery service!

My script is for 0.4mg sublingual tablets. I have tried cutting the tablets but they are tiny and it’s very difficult, even with a pill cutter to get it right. Even so, I did try and taper to 0.2mg but it really started interfering with my sleep. I could manage 0.4mg one day then 0.2mg and cycle that without really feeling much difference. But going down to 0.2mg every day, I just couldn’t sleep after the 2nd night.

My job is in sales so as I said it’s pretty high pressure and I really have to be thinking on my feet. Lack of sleep is not good for my concentration.

In fact, I am about to take a new position as international sales manager. Being on bupe has at least enabled me to focus on my career rather than getting high and I have done quite well. But, in reality I certainly am putting on quite a big front. I feel like I am acting as this sales person when really I was trained as a graphic artist so it’s not in my nature. But the money is good so this drives me.

But, I feel like this facade could easily break if my sleep schedule is ruined and I start to feel scared and weak again.

Hence my worries about time off work etc.

I know it’s not the end of the world being stable on bupe. But that’s kind of been my philosophy for the past ten years. Hence why I have been on it so long !

The downside is the trips to the recovery service and chemist. They obviously want me to quit so they can claim their bonus. That fact coupled with their lack of detailed knowledge on bupe withdrawal makes me kind of concerned about my situation with them.

Sorry, I am not really sure what I am asking or saying. I guess I am just venting. I don’t have anyone to talk to about this. I don’t have any friends who are recovering addicts. I don’t go to any NA meetings or anything. I don’t have counselling or anything like that. My recovery service - I meet with someone for about 5 minutes who knows nothing about drugs and then they give me a script. That’s it.

 

[EvidenceOfTheResurrection]

No man it’s good to share details. All makes sense to me.

I only wonder about two things. One is whether youre really living a facade or just having thoughts that you are. I’m guessing they know your background? You must be ok at your job to keep it, and even get a promotion it sounds like. I bet youre fine. Do you have any negative view of your job, or of salesmen or anything? They’re important and make economies work. Is why they make good money. Free market tells the truth about such things.

Feel free to ignore my questions. Only if helpful.

Second thing is that Ive had only low/moderate success getting professionals to understand bupe. Then again Im not great with people. Maybe make sure you are prepared for any outcome. You can always go somewhere and get 2mg suboxone, which is easier to divide anyway, and lasts longer than a month. If ever do that, just pick it up every month for awhile or they’ll wonder.

You may not want to do this, or it may not work right for you.. totally just throwing it out there: It is sometimes possible to crush a pill and carefully divide it into fourths with a credit card and take three of them a day (0.3mg).

I’m surprised to hear there are 0.4mg bupe sublingual pills. I’m understanding correctly right? If so, the very existence of such a thing should make people question whether that’s an insignificant dose.

 

[Johny2]

Thanks for sharing your thoughts.

Well, the job thing is definitely a challenge. I do struggle a bit if I’m not on top form but then I suppose most people do. At least I have Chatgpt now to help me write reports! Lol. But still. It scares me to think of trying to work while withdrawing. I might be able to manage it if I was a gardener or something, physically working solo. Not in an office where my performance is constantly monitored. Hmm.

I guess you mean 0.2 suboxone? I’m not sure where I could get it except possibly the black market but then it always seems to be higher dose tablets.

Yeah. Definitely 0.4 sublingual. Sublingual gets a bad rap but it’s always worked a charm for me.

 

[EvidenceOfTheResurrection]

Lol.

I meant 2mg as strips, which are then easier to fold and/or cut into small doses than a pill would be. Plus after a couple months one has a year’s supply.

But take heart; the full-opiate dosing region goes up to almost 2mg a day. So in that way, 0.4 is already great progress. Still will need tapering somehow imo and ime. But compared to like 1mg a day, way easier.

 

[Johny2]

Ah I see. Yeah, If I had switched to the strips it would definitely be easier.

So, tapering further down from 0.4mg will definitely make it a smoother ride when the final jump off is made?

Sorry, I didn’t answer your last point about crushing the tablets. Yes, this could be an option if I was careful.

Ultimately, I am now in two minds as to what to do. Do I just forget coming off it for now and stay on the 0.4mg because I certainly can’t deal with completely coming off at this time - so, is the effort of further tapering even worth it?

Or do I continue to taper by crushing the tabs and gradually taking less and less?

As I say, it really depends on the benefit of further tapering. Is it possible to taper to a dose that’s so low that finally coming off the bupe causes much more of a minor disruption than that of the account given by MuertaMan for example? (Up to a year to feel normal)

 

[MuertaMan]

I know its technically not how tapering is supposed to be done but I never jived with dropping small amounts over long periods of time, I just decided Im gonna do this and let myself go into withdrawal and would see how long I could handle the misery and then take a tiny piece and then do the same thing again. I had no set schedule nothing just went straight from 6mgs to cold turkey and then taking a piece every few days when I couldn't stand it. I did that for about a month and finally ran out and had nothing left so I had no choice but to face the music. Im scared to go through it again because I know what Im facing but so much of it is mental and Im trying to remind myself that. Sure its gonna suck for a few weeks/months but thats a tiny blip in the scheme of things and while it feels eternal while you are in the moment it will feel like a distant memory at some point down the line and it will be in the rearview mirror. I can see how the situation sucks because of the nature of your job having to deal with people, my advice would be to take kratom in that situation. If you could transition to kratom for like a month or two and then go off that it would cushion the blow and not make it so hard.

 

[EvidenceOfTheResurrection]

Ah I see. Yeah, If I had switched to the strips it would definitely be easier.

So, tapering further down from 0.4mg will definitely make it a smoother ride when the final jump off is made?

Sorry, I didn’t answer your last point about crushing the tablets. Yes, this could be an option if I was careful.

Ultimately, I am now in two minds as to what to do. Do I just forget coming off it for now and stay on the 0.4mg because I certainly can’t deal with completely coming off at this time - so, is the effort of further tapering even worth it?

Or do I continue to taper by crushing the tabs and gradually taking less and less?

As I say, it really depends on the benefit of further tapering. Is it possible to taper to a dose that’s so low that finally coming off the bupe causes much more of a minor disruption than that of the account given by MuertaMan for example? (Up to a year to feel normal)

I used a metal spoon and a ceramic plate and put my fingers around the spoon so it didnt shoot away. Anything else some of the powder got ground into it. Maybe that’s obvious though.

Yeah, anything from 0 to 1.8mg is the full-opiate dosing regime. Belbuca max dose is 900 mcg twice a day which is 0.9 x 2 = 1.8mg. The different roa doesn’t matter much (belbuca is put in the mouth on inside of cheek. Annoying, I dont recommend it)

The min dose is 0.075 mg twice which is 0.15mg. So 0.4 > 0.15.

There’s room to taper if interested in that option. Specifically, according to the FDA and Belbuca manufacturer, there’s room to taper to 0.15mg before quitting, with 0.15 not being a meaningless dose.

One final option is to swallow the dose and take like three times as much. Probably about equivalent. Might need to experiment. Only if the difficulty of getting low doses is too much, because oral introduces uncertainty when you’re certain about doses now. With the limited info I have, I think if it were me then maybe Id take 0.3 for a couple months after the new job gets rolling. Or 0.2 0.4 0.2 0.4 like you said.

I might concurrently pursue getting 2mg strips if the current prescribers were worrying me about maybe saying my dose is meaningless and stopping it suddenly.

Im being a bit anal by writing an essay about your situation lol, as it’s not an extreme situation. But stopping 0.4 would be meaningful and tapering more would help. However you do, you won’t be feeling it for a whole year. Maybe if you started at 1.8 you would

 

[Johny2]

Ok thanks guys!

Yeah, I tried that method many years ago, in a similar situation but not with Bupe and only after being on the stuff a few months. It was hell. You deserve a medal for that ! If you can do that, a normal supervised taper will likely be much less of an ordeal.

Kratom is not something I’ve ever messed with. I’ll look into it. Thanks for the tip.

Yeah, I have crushed many a pill in my time tbh. I would likely do a similar thing with a spoon on a plate and have the whole thing recessed in a bin or bowl for secondary protection against bits flying out the side. Lol.

Ok. I really appreciate the input. Definitely I’ll research more into Belbuca.

I’ll also try the pill crushing thing and see what happens. If it’s worth tapering further then that’s what I’ll do! I am pretty sure I can taper down if the increments are small enough. But getting small enough increments will be quite a challenge!

 

[EvidenceOfTheResurrection]

This was helpful for me too - processing my bupe experience. If you end-up communicating about belbuca, note the different route of administration. It’s buccal (stick to inside of cheek). But you can reply by noting buccal has slightly *less* bioavailability than sublingual. So if a dose is meaningful when buccal, is meaningful sublingually. Good luck and Godspeed

 

[EvidenceOfTheResurrection]

My only experience with kratom was not good. My understanding is that above a certain dose, one metabolic pathway gets overloaded and it becomes an opioid agonist. I was stuck dependent on the opioid aspect, but it does other stuff too. That other stuff wasnt good. Felt like I was eating a cup full of poison ivy, laced with morphine, because I had to have the morphine. Lol.
But other people have very different experiences. I eventually got the purified form where the concentrate the one part that is the opiate, can’t remember the name - smaller vials of powder.

@MuertaMan