Question about onset of withdrawals and half life

[ElleAZ]

I am trying to reconcile two camps:

One says that you can avoid withdrawals if you can avoid dependency and that is determined by time on the medication.

IOW, taking Valium daily for less than a week will avoid dependency.


The other camp says that ANY level of medication will provide withdrawals if there is enough in your body.

This addresses half life and the presence of medication.

IOW, your withdrawals will start in 5-7 days because of half life.


So, which is more accurate?

Or is there an agreement between the two that I cannot yet see?

Does the first opinion assume smaller dosages with less time and it really doesn't have to do with time/exposure at all?


I have heard many say that a short sub taper will prevent sub dependence. I did that. But my half-life is still pretty high going into day 5 without subs. So are my withdrawals contingent on exposure to the drug, or the amount still in my body?

I don't see it as often here, but on Drugs.com they absolutely do not accept the short sub taper as being useful and they insist it will still be fraught with withdrawals. Thewir taper plan guarantees longer exposure to subs which, according to the first camp, would create the very dependence that requires their intensive taper.

 

[Keif' Richards]

ElleAz, I totally get where you're coming from. You want more information and you want a better understanding. Unfortunately, even given the precision of modern medicine, we are nowhere near, at least from where I'm standing, able to do anything but hurl vaguely-educated guesses at you. Vague is the operative word here. What you have described in your post regarding 1-week between uses is as good as it gets. When we look at drugs like Diazepam (Valium) our work only becomes more difficult.

Diazepam and other old-school Benzodiazepines have difficult to chart, unpredictable natures due to the fact that their metabolism involves the body converting Diazepam into further active constituents, mainly Desmethyldiazepam/Nordiazepam (Nordazepam), which itself has a half-life of ~36-200 hours. Anyone with a basic understanding of math can glean from this that the half-life of Diazepam and its active metabolites and the subsequent duration of effect on a given subject, are highly unpredictable. I'm not going to get into any more specifics, but there are many variables at play, including matters of inherent physiology and even diet.

Newer Benzodiazepines like Alprazolam (Xanax) for instance, are easier, but still difficult to chart, given the fact that it is readily metabolized and excreted without active metabolites of significance.

In closing, to answer your question, you can only use the information that you already possess as a very rough guideline and you have to listen closely to your own physiology. Especially given the fact that you're using more unpredictable drugs like Diazepam, you are going to be the best resource. I'm going to leave this open, but you're probably not going to do any better than what I've given you. It's not that I'm so smart or knowledgeable, it's that nobody can know. You would have to go in for close diagnostic testing to get anything more accurate than what you can learn yourself by listening closely to your body.

 

[ElleAZ]

Thank you. I have seen these two opinions clash repeatedly online. It upsets me that this extended taper is applied to every situation, even those with small habits who may not need the extended suboxone exposure if dependence hasn't happened yet.

BUT, if it is not about length of exposure but the amount of the drug itself, then it makes sense to taper when you start out your detox with larger doses and drop quickly down.

Then last night I found a physician written opinion that it is about replacing the elements in the brain that have been damaged and it has nothing to do with time or dosage. This, of course, is something that we cannot predict. But it is a third approach to understanding what triggers and sustains withdrawals.

 

[Pilll_head]

Hi Elle AZ, I wouldn't focus on the half life, all this really does is tell you how often a drug needs to be dosed and when taken regularly, how soon your body becomes saturated (we call it steady-state). This is what your body is doing to the drug. Dependency is a result of what the drug is doing to your body, and they aren't necessarily connected. I agree with Keif, there will be a lot of variability from person to person and definitely from drug to drug to really have a sensible debate between these two arguments. An MD who has direct experience with prescribing that drug to patients can give you the most informed answser as to what you can expect as far as risk of dependency / withdrawals.

 

[Keif' Richards]

Thank you. I have seen these two opinions clash repeatedly online. It upsets me that this extended taper is applied to every situation, even those with small habits who may not need the extended suboxone exposure if dependence hasn't happened yet.

BUT, if it is not about length of exposure but the amount of the drug itself, then it makes sense to taper when you start out your detox with larger doses and drop quickly down.

Then last night I found a physician written opinion that it is about replacing the elements in the brain that have been damaged and it has nothing to do with time or dosage. This, of course, is something that we cannot predict. But it is a third approach to understanding what triggers and sustains withdrawals.

Be weary of anyone who says "Everyone else in modern medicine is wrong, this is in fact how this process works". I understand that this is how "breakthroughs" come about, but these guys are more often than not, quacks.