Desperate Need advice kicking heroin.

[Needs_Advice]

Hi everybody…

I’ve been a long-time ‘lurker’ here on BL, have found this community to be a wonderful source of comfort & advice, and think that the time has finally come for me to make my first post. First, as I’m not all that familiar with the forum organization, please forgive me if I’m posting this in the wrong place! I suppose that I should begin by attempting to sum up my back-story…and let me apologize in advance for the extremely lengthy post…

I am an opiate addict, going on 4 years. I have never injected anything and my ROA has always solely been insufflation. I’ve had several periods of total abstinence, the longest of which was ~6 months. I also suffer from co-occurring mental health issues, including treatment resistant OCD, treatment resistant MDD, Generalized Anxiety Disorder, ADHD, and severe cPTSD. I was also previously on Suboxone (prescribed) for ~1.5 years (11/17-06/19). I’m the survivor of an extremely abusive relationship, which I’ve now been free from for over 2 years. My ex was an addict & was also the person who introduced me to taking opiates. During the first 2 years, the only thing that I took were real (not pressed) roxies. After that, I progressed to taking heroin. At first, I’m pretty sure that it was actually heroin, but as time went on, I believe that it’s now likely to also contain fentanyl (as nearly all street heroin does these days), regardless of making every effort to avoid it.

At my heaviest period of use, I was snorting ~1.5-2.0 grams daily. I haven’t had any desire to actually get ‘high’ for over a year now, and have only been taking the bare minimum in order to feel ‘normal’ & not be sick. Over the past several months, I have managed to taper down to only needing ~1 point (0.10 gram) daily, in order to not be in withdrawal, and I’m 100% at the point where I’m READY & WANT to quit!

Other medications that I’m prescribed:

- I’m currently prescribed 2mg clonazepam (1mg twice daily) for anxiety, but I actually only take 0.5mg before bed, because I don’t want my body to develop a higher dependence than necessary…I realize that I am probably physically dependent on the 0.5mg daily, but I’m not ‘addicted’ to the clonazepam & have never abused it.

- 40mg Ritalin daily (20mg twice a day). I’ve never been a fan of stimulants & I’m definitely not addicted (or even really dependent) on my Ritalin prescription. In fact, many days often go by where I forget to take it entirely.

- Buprenorphine/Naloxone 8-2mg films. I’m prescribed 30 films per month (1 daily), but I haven’t actually taken any for several months. Every single time that I’ve attempted to take it, even the tiniest amount has lead to precipitated withdrawal (even when I’ve waited for 24 hours after taking my last opiate).

- 1800mg of Gabapentin daily (600mg three times a day) for the off-label use as a mood stabilizer. I only take approximately half (~900mg) of what I’m actually prescribed, but I take it in (what seems to be) a somewhat novel way… Over the past several months, I’ve been using it to cut my own ‘dope’. I get the 300mg capsules (each of which contains ~0.38 grams of powder). I open them & mix the contents with the heroin, in order to weaken it & stretch it out. I’ve managed to taper myself down to ~1 point (0.10 grams) a day by doing this.

I usually add 2 capsules of gabapentin (~0.76 grams) to 1 point (0.10 grams) of heroin, which equals ~0.86 grams total weight. If I only use 1 capsule of gabapentin to 1 point of heroin, it comes out to a total of just under half a gram (~0.48 grams).
I honestly feel extremely embarrassed to tell you guys about this & realize that my reasons for doing it probably seem stupid to most people…however….I also realize that I need to be 100% honest with you all in order to receive the best advice. My reasons are as follows:

1) It’s easier for me to take several, weaker (more diluted), lines multiple times throughout the day after I’ve ‘bulked’ it up with gabapentin.

2) I realize that I’m also somewhat tricking my brain into feeling like I’ve done a bigger line, even though the actual amount of opiate that it contains is less.

I desperately need advice on what would be the best way for me to quit opiates with the absolute minimum level of withdrawal possible. I tend to experience much longer acute withdrawal times than is ‘typical’ and have also experienced severe PAWS (most likely exasperated by my co-occurring mental health issues). I can obtain any recommended OTC medications & also have the following prescriptions at my disposal:

- Clonazepam (1mg tablets)
- Gabapentin (300mg capsules)
- Clonidine (0.1mg tablets)
- Buprenorphine/Naloxone (8-2mg films)
- Ritalin (20mg tablets)

When I was on Suboxone, I only took 2mg daily for ~1.5 years. I tapered down to 0.5mg daily before I jumped off, and still experienced acute withdrawal symptoms for over 30 days…the worst of which was TERRIBLE insomnia (I barely slept at all for an entire month)! If I could somehow manage to avoid precipitating withdrawal, I would be open to using Suboxone VERY short-term (during detox only), but do not want to develop a dependency to it again, as I’m ready to stop all opiate use for good (buprenorphine included). I’ve attempted the Bernese Method in the past, but it takes me so long to induct, that my fear is that I would become physically dependent on buprenorphine by the time that I was able to discontinue full-agonists. Additionally, even taking an amount as small as 0.25mg of buprenorphine causes me to precipitate withdrawal, so I would end up needing to take a significantly larger amount of heroin than I’m currently taking in a full 24-hour period, just to offset the effects of PW.

Is there anything that anybody can recommend that would be a good substitute for me to cut the heroin with (besides Gabapentin)? I’m also trying to stop taking the Gabapentin, so I would ideally like to use a different cutting agent to further ‘dilute’ my doses.

Also, can anybody give me some kind of timeframe as to how long & how severe the withdrawal process would be if I was to just try & stop ‘cold turkey’ from a 1 point a day habit? I realize that many different factors play a role in this, but considering my background, I was wondering if anybody might be able to give me some kind of idea as to what I might expect?

I’m at a point where I’m (for the most part) able to control exactly how much I take. I’m the first person to admit that I’m a complete & total wuss when it comes to withdrawals. The most difficult part for me is the total inability to sleep (I’ve struggled with bad insomnia in general for most of my adult life). The next worst thing would probably be the excessive sweating combined with hot flashes & then cold chills. The last time I quit, I remained in a state of freezing cold for months (even when dressed in a hoodie/sweatpants in the middle of 90 degree weather). Of course, I also experience gastrointestinal upset & all of the other ‘usual’ symptoms.

Concerning PAWS & my overall mental health, I think that I’ve actually finally found something that helps! I hadn’t taken psychedelics of any kind since high school, until a friend of mine recently suggested that they may help with my treatment resistant OCD & depression. Upon trying a relatively small amount of some very high quality LSD, I found that it almost completely eliminated my OCD symptoms for a period of several weeks! It also helped a LOT with my depression symptoms. Obviously, this is not something that I’d take while in the phase of acute withdrawal, but I think that it may be a real game-changer for me in helping to overcome PAWS.

If I’ve left something out that could help in answering any of these questions, please let me know, so I can provide any additional necessary details. Thank you SO INCREDIBLY MUCH in advance for all your help & suggestions!

 

[Eligiu]

I think the biggest issue here is that at a guess, you are not using heroin my friend. You're using fentanyl. That is a guess, but I don't really think anyone using 'heroin' in the US is using heroin.

If you are in another country or you actually are sourcing heroin, then you are not waiting long enough to induce onto suboxone. You need to be in at least moderate withdrawal.

Unfortunately, the only suggestion I know of regarding tapering fentanyl onto suboxone is the Burnese Method.

It's definitely a problem at the moment in how people can quit. Fentanyl is so much harder to get off than heroin and people really don't know the exact dose they are on.

 

[Needs_Advice]

I think the biggest issue here is that at a guess, you are not using heroin my friend. You're using fentanyl. That is a guess, but I don't really think anyone using 'heroin' in the US is using heroin.

If you are in another country or you actually are sourcing heroin, then you are not waiting long enough to induce onto suboxone. You need to be in at least moderate withdrawal.

Unfortunately, the only suggestion I know of regarding tapering fentanyl onto suboxone is the Burnese Method.

It's definitely a problem at the moment in how people can quit. Fentanyl is so much harder to get off than heroin and people really don't know the exact dose they are on.

I totally agree that it almost certainly has fentanyl in it, which explains the issue that I’m having with precipitated withdrawal. Strangely, out of all my sources, it keeps me from being sick the longest…as in one point will last me ~18 hours (as opposed to the ~8 hours that I might get from other stuff). I was always under the impression that fentanyl withdrawals came on sooner, due to it’s short acting nature.

Having experienced precipitated withdrawal on multiple occasions (even after waiting 36 hours), I’m absolutely terrified to take buprenorphine now. I’ve heard of cases where people on fentanyl have experienced PW up to 7 days after their last use! Even 0.25mg of Suboxone has given me PW. I’ve tried the Bernese Method & I got sick literally every single time that I took the buprenorphine, no matter how slowly I tried to induct. I’m at my wits end & becoming increasingly hopeless.

 

[Eligiu]

I totally agree that it almost certainly has fentanyl in it, which explains the issue that I’m having with precipitated withdrawal. Strangely, out of all my sources, it keeps me from being sick the longest…as in one point will last me ~18 hours (as opposed to the ~8 hours that I might get from other stuff). I was always under the impression that fentanyl withdrawals came on sooner, due to it’s short acting nature.

Having experienced precipitated withdrawal on multiple occasions (even after waiting 36 hours), I’m absolutely terrified to take buprenorphine now. I’ve heard of cases where people on fentanyl have experienced PW up to 7 days after their last use! Even 0.25mg of Suboxone has given me PW. I’ve tried the Bernese Method & I got sick literally every single time that I took the buprenorphine, no matter how slowly I tried to induct. I’m at my wits end & becoming increasingly hopeless.

I understand that. The only solution to this is making sure the heroin that you use is legitimate heroin. In Vancouver the Drug Users Liberation Front give out free tested, safe substances contrary to federal law. People such as yourself need a non contaminated supply to have any chance of inducting onto maintenance therapy.

I've also heard methadone can be a better option with fentanyl addiction, due to the lesser issue of PW.

 

[Pissed_and_messed]

I can't say how it otherwise syncs with opi WDs but mirtazapine is the strongest knock-outter I have ever done and significantly decreases my motoric activity, amount of sweating and anxiety and causes constipation. Higher doses are less sedative but 45 mgs makes me agitated. It also goes fine with gabapentinoids what I have tried.
I don't remember anyone mentioning using it as aid in opi WDs, I don't know if there is reason for it.
I have never withdrawed off of opis.

 

[THECATINTHEHAT]

Personally I would strongly suggest you find a new physician, anybody that has you on that cocktail of medicines is not to be trusted.

Seriously, it’s fucking outrageous having someone on that combination of meds (and I’ve been on bupe, quetiapine, diazepam, sodium valproate and amphetamine at the same time before so this isn’t an attack on you).

 

[Needs_Advice]

Personally I would strongly suggest you find a new physician, anybody that has you on that cocktail of medicines is not to be trusted.

Seriously, it’s fucking outrageous having someone on that combination of meds (and I’ve been on bupe, quetiapine, diazepam, sodium valproate and amphetamine at the same time before so this isn’t an attack on you).

I 100% agree with you & describing my shrink as irresponsible for prescribing me this combination of meds is a huge understatement! I’m honestly done with pharmaceuticals & am in the process of stopping them all & planning to trade my shrink out for a therapist with experience in treating both OCD & domestic abuse survivors. I’ve tried almost every medication under the sun & have found my depression & OCD to apparently both be resistant to treatment with medications.

 

[THECATINTHEHAT]

I 100% agree with you & describing my shrink as irresponsible for prescribing me this combination of meds is a huge understatement! I’m honestly done with pharmaceuticals & am in the process of stopping them all & planning to trade my shrink out for a therapist with experience in treating both OCD & domestic abuse survivors. I’ve tried almost every medication under the sun & have found my depression & OCD to apparently both be resistant to treatment with medications.

That's amazing, congratulations for coming to this conclusion and not just continuing to be 'happy' you have a doctor that is free and easy with the meds!

Where are you at right now in terms of your meds and drugs? Do you need help with advice tapering? Help planning which order to try and do things in? Thoughts about how to try and tackle life and stay clean once you have detoxed? All of the above?

Let me know what would be useful and I'll try to lay down some advice as replies have been a little thin on the ground.

 

[paranoid android]

I have never taken bupe before but im sure it could be tapered like any other opiate. Do u have a source for a shoerter acting pharm opiate like morphine or dilaudid? either would substitute for the probable fentsnyl your getting and are much safer then using street heroin. If your generous shrink would write bupe maybe he would switch you to another opiate. Anything beats street heroin ive lost so many friends to that shit. morphine especially long acting oral morphine is pretty easy to taper with.

 

[Needs_Advice]

I understand that. The only solution to this is making sure the heroin that you use is legitimate heroin. In Vancouver the Drug Users Liberation Front give out free tested, safe substances contrary to federal law. People such as yourself need a non contaminated supply to have any chance of inducting onto maintenance therapy.

I've also heard methadone can be a better option with fentanyl addiction, due to the lesser issue of PW.

Unfortunately, we don’t have anything remotely close to the same level of forward-thinking healthcare here in the States as you do in Canada. You’re extremely lucky to live in a country that has such an amazing healthcare system!

 

[paranoid android]

Unfortunately, we don’t have anything remotely close to the same level of forward-thinking healthcare here in the States as you do in Canada. You’re extremely lucky to live in a country that has such an amazing healthcare system!

Im from Canada to don't feel to enbious for the most part it sucks. I live on the east coast and we have nothing like that here. Beyond free needles at the exchange theres really not much help for addicts here

 

[THECATINTHEHAT]

Have you tried moving on to bupe since tapering down? If not then it's possible that when you were trying before your habit was just too big to be covered by bupe due to it's ceiling dose. Haven't they been drug testing you at your clinic? How have you been getting away with not taking the bupe and using instead?

If you wait for long enough then you WILL be able to move on to the bupe, if the other opiates have completely drained from your system and you are in full blown withdrawal then the bupe will work and it will make you feel better. Maybe not completely but if you want to detox then you are going to have to accept the fact that you are going to have to go through some pain, there's no pain free way of doing this. You have tapered a lot though so I can't imagine it won't cover you.

I'm from the uk and all our heroin is still heroin so I'm not a great person to comment on the specifics of going fent to bupe. If you're going to detox then I would advise stopping taking your ritalin as stimulants are only going to exacerbate withdrawal symptoms, all you're going to be doing is lying around anyway so you're not going to be needing to concentrate or achieve anything. I would carry on taking the rest of your meds as normal for the moment, and if you're making a serious attempt to detox then you can use the extra gabapentin and clonazepam you have to mitigate the wd symptoms but obviously you need to limit them and taper back to your regular dose otherwise you're just making those addictions worse. You can up the clonidine too but you need to be careful with that because of the effect it has on blood pressure, we use a similar but different med in the UK that I can't remember the name of for the life of me (begins with an L) but I found it helpful when I had it on script. We can buy promethazine otc in the uk too so if you can get that then that's very useful as a 'non-addictive' sedative that can help with sleep.

Prepping your environment for a detox is really important, you need to be ready for the fact you might feel too ill to leave the house for weeks. Get some food in that you feel you will be able to eat once you're through the worst of it. Have a tidy/clean so you have a nice environment ready to go through detox in (clean bedsheets etc as you will be spending a lot of time there). Preferably tell some people what you are doing so they can drop in and support you. Get a load of films/tv series etc downloaded ready to watch, passing the time any way you can is important. Try to eat plenty in the run up to beginning detox so your body has some energy stores to get you through the period of not wanting to eat. Prepare mentally for the fact that you're about to go through a week or more of extreme discomfort and pain, if you're not ready to do that then it's probably not even worth starting. This will be painful, you have to be ready to accept that.

Me personally I would be doing all that and planning on switching to the bupe and then doing a short taper (three to five days) on that, just enough of it to ease the pain at the roughest point. It's hard to recommend dosages without being there to see how it is affecting you. You have a lot of meds available to help you there though, if you get organised with the other stuff then you're in a really good position to be able to get through. You can do this!

 

[Fertile]

I have noticed that small doses of buprenorphine seemed to reverse dependence. You must certainly can take full agonists 8 hours later (never tried it any closer) so you do not go into withdrawal. I didn't mess around taking it for months. From 80mg of oxycontin BID to nothing in 7 days.

It felt so good NOT to need to go out and waste money.

You don't realize that while you use, the rest of your life is put on hold. The hardest thing was to readjust to living clean.

I ended up back on Oxycontin because the pain got so severe that I collapsed, had a series of seizures and ended up in hospital. Even though I get a 28 day supply and never take more than i should, I hate the fact I'm still stuck on opioids.

 

[Bcdubzz]

Burnese method for Fentanyl use

 

[endlessnameless]

Apologies if I've missed something here, but if you're trying to come off a point (ie 0.1g) of heroin, which is very little, and you have Gabapentin at hand - why dont you try just using the Gabapentin? I've had decent success with using 600mgs of Gabapentin in order to come off a 0.2g a day habit which massively mitigated my symptoms. The issue would always be that I wouldn't be able to get enough time off work to go through with the process...

I'd imagine you've probably tried this already though. Its well documented online that Gabapentin and Pregabalin work for a lot of people when trying to lessen opioid withdrawals. Anyway I'm sure you've probably tried it given you have it at hand - or perhaps your tolerance to it could be too high for it to have an effect on quelling your symptoms of WDs given you've been prescribed it off label as an anti-depressant and given that fact, you've probably have been on it for a while.

Also - do you (or anyone else for that matter) find that Gabapentin and Pregabalin completely cancel out the affects of Diazepam?