Need Suboxone advice. I just started for the first time today.

[MBoxer511]

I'm coming off a 3 month binge of oxycodone and heroin. At my peak I was doing 60mg of oxycodone (2x 30mg Roxicodone) and 1-2 bags of heroin (all sniffed). I weaned myself down to no heroin and just 30mg of Roxicodone (spread throughout the day) before going to a Suboxone doctor. Last night at 6pm I took my last piece of Roxicodone (7mg). It was a tough night to get though and today I had my first appointment with a Suboxone Doctor. He prescribed me 8mg Suboxone strips and to take 4mg in the morning and 4mg at night. At 2:30pm today (20 hours after my last Roxy dose) I took 4mg of Suboxone. Within 2 hours I felt great. 4 hours after the first dose I began to nod a little but now (it's 9:22pm about 7 hours after first 4mg Suboxone dose) I feel okay. I'm also an adult Male and weigh 165lbs.

This is my concern: I'm really scared I made the wrong choice and should of just gone cold turkey off of the opiates. I've never taken Suboxone before and I'm reading the withdraw from Suboxone is even longer then fast acting opiates. I told my doctor the truth about everything and he said his plan is to use these first 48 hours to test out the dose and use the first 1-2 months as maintenance with the Suboxone. Then use month 3 to taper me down so I can quit.

Does this sound doable? I'm considering just using the Suboxone I now have and doing a crash taper over 5 days before I get hooked on the buprenorphine. Is that a good idea? Also what are others experience with the withdraw and taper of Suboxone? I'm not in a zone where I want to get high to deal with life or boredom. The last month I keep trying to quit but break because of the W/D symptoms so I sought out Suboxone as possibly a way to help and break the cycle of spending money on pills and riffling though my parents medicine cabinet. I would really appreciate all of your experience and suggestions with this so I can decide what to do before too many days have gone by and I'm now locked in to taking the Suboxone.

Thank you in advance.

 

[BrohandasGandhi]

I was on Suboxone for about 6 months a few years ago at a very similar dose to what you are taking, although I was prescribed much more. In my opinion doctors tend to overprescribe Suboxone like crazy. They prescribed 24mg/day and I was taking 8-12mg maximum, but probably even needed less. With that low of a dose and time period of dependence you may be able to get away with less than what you're taking now. I would play around with your dose a bit and see what the lowest per day you can tolerate without being sick or buzzing is. I was using 180-300mg of roxicodone, injected, or at least 7 or 8 bags a day, or high doses of whatever else I could get my hands on after nearly a year straight of hard usage, and 8-12mg of buprenorphine was just fine for me. I did this for about 6 months and tapered down for about a month cutting my dose rather quickly. I did feel withdrawal symptoms by doing it so quickly, but it wasn't intolerable. The final withdrawal was very light and lasted about 2 weeks. Everyone is different though and bupe withdrawal, even from low doses, may affect you differently than it did me. I'm not a doctor so I can't recommend an exact dose for you, but play with it a bit and see what the lowest dose is that you feel fine at, and talk to your doctor about it. He may be able to taper you down much more quickly from a lower starting dose.

I think you made the right decision going on Suboxone to try to get off other opiates. It can be a very useful and effective tool IF its used properly. I had to make the decision to taper myself down, because the doctors wanted to keep me on it indefinitely. It seems like you have a good doctor with a good plan though. I would listen to him, but try to get on as low of a starting dose as you can. It will make things much easier in the long run.

 

[QueenDopamine92]

True you don't have a bad habit you even weaned you could probably take 1 8mg Sub and not need more. If you start to feel shitty just do more. You definitely don't need it long enough to have withdrawl so why take it that long? 1 or 2 days of low dose of subs and you will be good.
Atleast that's all I needed when I was on a 100mg opioid pill a day habit. Ah those were the good ole days... 1 sub and no w.d.

 

[MBoxer511]

Thanks. So far I've only taken one dose of 4mg and within 2 hours all my symptoms were gone and I had a lot of energy. But then I started to get tired and nod out about 4-5 hours after taking that dose. Maybe I should wait as long as I can tomorrow until I withdraw again and see if 2mg works for me? Also can anyone tell me about what to expect with the withdraw after tapering off and stopping Suboxone? That's my biggest fear, that it will be longer and more drawn out. Every time I make it like 24-36 hours I crack from that damn RLS at night, get drugs and start all over again.

 

[BrohandasGandhi]

It is longer and much more drawn out, but it also isn't nearly as intense as a short acting opioid. If your doctor tapers properly the withdrawals will most definitely be manageable and you should even be able to get some sleep at night. Like I said before, everyone is different and reacts differently, but that is how it affected me. A little longer but much less intense. I'm sure that if you do a slow taper that you will have much less pain than I did because I did a fast taper. Even the first few nights after I started feeling the withdrawals I was able to sleep a few more hours than I would if I were kicking heroin or oxycodone. Your idea of 2mg when you start to withdraw sounds like a good idea. Try to take 2 or 3mg when you feel the first symptoms of withdrawal. If that works you can even try to go a little lower. My opinion is to go as low as possible so you have a shorter distance to jump when you and your doctor finally decide to taper. A 1 month taper from 2-4mg a day will be far less painful than a 1 month taper from 24mg/day. Make sure you're working closely with your doctor on this. He seems like the type of person with proper goals for you in mind. As in the goal of quitting instead of with indefinite maintenance.

 

[MBoxer511]

Thanks for the reply. Can you (or anyone else) give me some sort of timeline of what your suboxone withdraw was like? For example day 1 couldn't sleep, day 2 lighter RLS but manageable, etc. I think this will help me prepare for how much time to take off and what to expect when I finish my taper. I know everyone is different but even a ballpark idea will be helpful. I've been considering using the Thomas Recipe when I stop also but would like a detailed experience from someone so I know what to prepare for.

 

[MBoxer511]

True you don't have a bad habit you even weaned you could probably take 1 8mg Sub and not need more. If you start to feel shitty just do more. You definitely don't need it long enough to have withdrawl so why take it that long? 1 or 2 days of low dose of subs and you will be good.
Atleast that's all I needed when I was on a 100mg opioid pill a day habit. Ah those were the good ole days... 1 sub and no w.d.

Are you saying you avoided your w/d symptoms from a 100mg opiate pill a day habit using only one sub?! Is that even possible?

 

[BrohandasGandhi]

I would work closely with your doctor instead of following a recipe online. Support from a professional can be very helpful. I did my taper years ago, so I don't remember the exact time frame of everything and haven't been on bupe since then, but the worst of it was over within a week or two I believe. If you were to go from a 24mg/day maintenance dose to nothing at all I have heard horror stories of it being incredibly painful for more than a month. I know I did get at least some sleep every night. Since it is so long acting, the first day isn't the worst, its probably day 3, 4, or 5 I would say is the worst. RLS and all the classic opioid withdrawal symptoms were sooo manageable with even a quicker taper. The withdrawals will be much longer than the 3 or 4 days of intense pain of a short acting opioid, but the symptoms are far more manageable. I was even able to go to work after the worst few days were over. With a slower, physician directed tapering plan you may feel nearly nothing in the way of physical withdrawal as compared to coming straight off of your heroin/oxy habit. Just remember to be open and honest with your Doctor about all of this and he will help you more than anyone else can. Be open to the idea of counseling or a support group if its recommended by your doctor. If you truly want to stay clean just listen and be open and you'll be sure to succeed!

 

[BrohandasGandhi]

As for the Thomas Recipe, I just looked at it, and a lot of those things can definitely be very helpful if you don't have access to a physician willing to help you detox. I did use prescribed Ativan for sleep on the worst nights and on nights where I had to work early in the morning, but that always runs a risk of replacing an opioid habit with a benzodiazepine habit. A multi v is always a good idea for any addict as we tend to neglect our health when dependent. Potassium is helpful for RLS as well. Loperamide can be an invaluable tool for diarrhea during withdrawal and even can lessen other physical symptoms if its used incredibly responsibly. Just make sure to work closely with your doctor concerning everything and you'll have the best and safest outcome possible.

 

[MBoxer511]

Be open to the idea of counseling or a support group if its recommended by your doctor. If you truly want to stay clean just listen and be open and you'll be sure to succeed!

Thanks. I think I can deal with a longer withdraw if it's a lighter withdraw. It was the intensity combined with the lack of sleep that compounded over days that always killed me from fast acting opiate withdrawal. I'm already going to NA and Smart Recovery and have a pretty fulfilling life which is why my focus is on the physical part. I don't feel like I can't "face the day" unless I'm numb inside. The vicious cycle was I couldn't "face the day" because my nose was running, my body ached and I had to take a crap every hour. It's a real mindfck when you basically know that tomorrow you're going to have the flu, but you can push it off for a day so you can go to work and school if you just take this pill. But then just knowing that the day I stop is when I will have the flu again. I feel like this must be like what a person feels on death row. They know exactly when they will die, and I know exactly when I'm going to get sick; there's no surprise and I hate living on what feels like borrowed time. I had to plan my drugs around what I had to do during the week to make sure I had enough to get through certain events. It wasn't even about getting high, it's just trying to get normal so I can continue to perform at life. So it was that old cycle of "just use today so you can get through without being sick". But I'm sick and tired of being sick and tired.

Sorry about that off topic rant, I just had to get it off my chest.

They prescribed 24mg/day and I was taking 8-12mg maximum

If that was your experience coming off of a fast taper on 24mg of suboxone then that makes me more hopeful considering I'm starting off on a lower dose. Hopefully some more people will share their experiences of taper and withdrawal over the next coming days here.

 

[jdaen]

I have heard the horror stories about Suboxone as well. That said, I've been on it several times: 16mg/day for 8+ months and coming off it was no problem. I suppose it varies from person to person. I know it has been stated, but you can really go a long way with Subs. If I were to take an 8mg Sub and had only been on it for a day, I could take 4mg the next day and then jump right off (or take 2mg the following day). The drug has such an incredibly long half-life that it will be in your system helping you for a while. Like how they give diazepam to detoxing alcoholics: long half-life, long withdrawal, but overall very manageable because of how slowly you eliminate it.

If anything you could talk to your Dr. about clonidine? It helped me with my RLS at night and the sweatiness/goosebumps... I would say it was almost as effective for me as the buprenorphine itself!

 

[MBoxer511]

If anything you could talk to your Dr. about clonidine? It helped me with my RLS at night and the sweatiness/goosebumps... I would say it was almost as effective for me as the buprenorphine itself!

Thanks for your reply. That's a good idea I didn't think about that. If I could get something to kill off that damn RLS for the first few nights until it goes away on it's own I would be okay. The stomach issues I can deal with using Imodium. It's just the RLS that gets me. The sweating usually only lasts like half a night on day one for me when I w/d. It's the RLS that goes on for days. I really want to get the opiates out of my system not just replace it with another one. Is there a high chance of getting addicted to clonidine? If it's something I could take for like 5 days then quit without any withdrawals from that then it might be the trick.

 

[jdaen]

Its not something you will get addicted to psychologically, but if you take it for a long time and abruptly discontinue you can have rebound hypertension. It lowers your blood pressure...I dont see any abuse potential, you would just want to talk to you doctor about coming off of it before doing so! My Sub doc wrote me a scrip for Suboxone strips, clonidine (for a week), and Klonopin (for two weeks to help with sleep). I'm sure not all doctors would be cool handing out a benzo to an addict, but at the very least clonidine should be okay. In fact, until this post, I thought all people who were just starting on Subs got it for a week or so.

 

[MBoxer511]

Okay so it's been 3 days on Suboxone so far. 2 nights ago I had horrible insomnia. I didn't have any withdraw symptoms I just couldn't fall asleep. I think the dosage of Suboxone might of been too high because it gives me this big burst of energy. My doctor (I spoke with him yesterday afternoon) said it could be because I'm withdrawing from the opiates and even though I'm on Suboxone I'm still feeling some effects. We both agreed that I drop my dose from 4mg morning and night down to 2mg morning and night.

That did seem to help, I am still a little wound up (which is why I'm writing this post at 2:50am lol) but it seems more manageable. I found a chart for doctors that explains how to prescribe Suboxone, the various amounts to give, and safe dosages of sleeping aids (including ambien) to take along with Suboxone. I'm considering taking a 5mg dose of ambien tomorrow night (it's Saturday night right now) if I still have insomnia tomorrow.

Also this guide has the chart for how to start and then taper off of Suboxone safely and with minimal to no withdraw symptoms. Very helpful I think, especially if you're someone who is getting Suboxone off the street to self-detox and is looking for a guide of how to use it efficiently. You can view the guide here: http://www.naabt.org/documents/Suboxone_Dosing_guide.pdf

 

[GreenGnome]

For you having tapered to 30mg oxy. 4mg sub is way too high. I would take it 1mg at a time until you feel okay. IME 1mg is enough for such dose, but everyones different.