Should I go back on buprenorphine?

[simplescience6]

Eleven years ago I was put on buprenorphine to deal with a heroin addiction. I stayed on it for 2 years at 8mg a day. My first attempt at quitting saw me jump off at 8mg with no taper. I lasted three months, but the PAWS were interfering with my ability to finish school. I decided to go back on at 2mg a day. After I finished school, approximately 10 months later, I jumped off again, at 2mg, no taper. It was absolute hell for 6 months, but I made it through.

Since ceasing buprenorphine therapy I've never felt right. Sleep has been a serious issue, as has a growing dark depression and anxiety disorder. For the past 7 or 8 years I've been seeing psychiatrists, psychologists, addiction medicine specialists, been put on various ssri's, snri's, anti-psychotics and various other meds, and been involved in AA. Nothing seems to help, some things/meds make it worse.

About a year and a half ago I began using heroin again, sporadically. Initially I kept it on the fringes, no more than once a week, and very small doses. Gradually I began to use more and more, and though I never developed another daily habit, I would experience mild to moderate acute withdrawal symptoms after using a couple of days a week. I would get through these withdrawal periods using other meds.

It's currently been about 5 weeks since I've last used, and I continue to experience some serious PAWS...no sleep, severe depression and anxiety, etc. I'm considering going back on buprenorphine at a very small dose, and staying on it for the foreseeable future. I believe it would go very far in alleviating my depression, anxiety, insomnia, and improve my overall quality of life. My first time around with bupe I was in my mid 20's, I'm now in my mid 30's. I hesitate to go back on this med because I know how ridiculously difficult it is to quit. However, I don't intend to quit again, barring severe unforeseen side effects developing. I'm currently on moderately large doses of Gabapentin and Lyrica, both of which I'm very physically dependent on. Lyrica withdrawals are as horrible or worse than opioid and/or benzo w/d's. I believe the burprenorphine would go far in assisting coming off of these other meds, meds that have brought unwanted side effects.

Is a lifetime of buprenorphine maintenance a viable option? Is there anyone out there with a situation similar to mine (having ceased buprenorphine for a considerable time, but still struggling with a dark and worsening treatment resistant depression) who has made that decision? If so, how has it treated you?

All opinions are welcome and appreciated!

 

[justtakethat]

Thats a horrible life dependant on a substance. Stay non dependant man those PAWS will go away eventually man. Then you can use opiates once in a while recreationally

 

[simplescience6]

My doctor recently prescribed Baclofen in an attempt to allay my anxiety and PAWS. So far it is helping. Still no decision regarding buprenorphine.

 

[###]

I feel your pain. Everyone is different. Some of us wouldn't anyway have normal body chemistry, and feel well. In your case it looks that it is messed pretty bad for whatever reason. Probably because of your past long term addictions.

May I ask why have you chosen bupr? No other options beside methadon? I would suggest you try something with not so long half life, and not prolonged release. Some contries offer even H. Where I live we can get liquid M hydrochl., which has quite short half life, and not so nasty side effects. How I imagine it, with something like M (no slow release stuff) you don't influence your natural production of endomorphines and such that much. I consider these slow release stuff to be evil. They can only be good for pain management in some cases as I see it. Consider that there is almost no substance in our body hormone, neurotransmitter or whatever which secretes 0-24! And what they do, you go to substitution program, and for some reason they decide to make the situation worse than it was when you were hitting H two times per day. That is sick. No wonder you end up totally fucked up after few years.

Maybe some don't want us to quit : )?

 

[justtakethat]

^ there will always be withdrawals and those nights of hell gettinf nonsleep and restless

 

[pillman1224]

^ there will always be withdrawals and those nights of hell gettinf nonsleep and restless

that was last night for me. im taking a t break and tried bupe friday and all it did was delay the wds. the bupe just started over my wds cept for coming off fentanyl, morphine, and oxy i had to deal with bupe wd to.

 

[justtakethat]

Thats good that ur taking a tolerance break. For somereason just 3 days of tram use is causing me restlessness now so i had to deal with that also but indica really helps, ill just not go over 2 days from now on

 

[simplescience6]

I feel your pain. Everyone is different. Some of us wouldn't anyway have normal body chemistry, and feel well. In your case it looks that it is messed pretty bad for whatever reason. Probably because of your past long term addictions.

May I ask why have you chosen bupr? No other options beside methadon? I would suggest you try something with not so long half life, and not prolonged release. Some contries offer even H. Where I live we can get liquid M hydrochl., which has quite short half life, and not so nasty side effects. How I imagine it, with something like M (no slow release stuff) you don't influence your natural production of endomorphines and such that much. I consider these slow release stuff to be evil. They can only be good for pain management in some cases as I see it. Consider that there is almost no substance in our body hormone, neurotransmitter or whatever which secretes 0-24! And what they do, you go to substitution program, and for some reason they decide to make the situation worse than it was when you were hitting H two times per day. That is sick. No wonder you end up totally fucked up after few years.

Maybe some don't want us to quit : )?

Yeah, I live in the US, where buprenorphine and methadone are your only legal options, unless you have pain management issues. Kratom has been suggested to me as a possible alternative to buprenorphine...it's another partial opiate agonist.

If you don't mind my asking, what country are you in?

 

[###]

I sent you PM regarding your question. Just forget Kratom. I am talking from personal experience. People who suggested you that are clueless (about this topic at least.). Never mind being partial agonist, it is about one billion times weaker than buprenorphine. No chance you could consume enough tee (even concentrated one) to replace bupe. Is it like that in all states?

 

[simplescience6]

It's been a while since I started this thread, and I wanted to update it.

I still haven't made the commitment to buprenorphine. I did relapse briefly with heroin, for only a few days. The most time I've been able to put together is about 6 weeks. I believe I precipitated the relapse by attempting to reduce my dose of both lyrica and gabapentin too quickly, leading to withdrawal symptoms, which brought on the relapse. I'm very sensitive to both of those medications and have had a very difficult time reducing my dose.

After my relapse, my opioid withdrawal symptoms were fairly acute...more than I was expecting or prepared for. I ended up taking 1mg of buprenorphine to deal with it. This helped, although I felt guilty for giving in and taking it. The constipation that followed was ridiculous. I took a dose of miralax that day...nothing. I took a double dose of miralax and 200mgs of colace the following day...still nothing, that day or the following day. It wasn't until 72 hours after that small dose of buprenorphine, and all of the laxatives mentioned, that something finally happened. This is another reason I've continued to try to remain completely opioid free, maybe my most pressing concern at this point. Constipation was always an issue for me while taking subutex in the past, however this is beyond anything I experienced prior. I've read and been told that both lyrica and gabapentin can be constipating as well.

So here I am, months after posting my dilemma, in basically the same place. I do have a new psychiatrist, with whom I'm trying even more anti-depressants...but it's difficult to delineate between the the underlying depression and the depression brought on by the post acute withdrawal I've been experiencing. However, as I stated above, there's a strong underlying depression, and most all anti-depressants I've tried in the past few years bring on feelings of intense anxiety, sweating, etc...

One additional medication I've been prescribed is baclofen, a gaba-b agonist. I use it sparingly, as it is very addictive from what I've read. It helps a bit with anxiety, and a lot with sleep.

 

[justtakethat]

Unless you can muster up some will power you will be in this problem the rest of your life

 

[Phil.McKeer]

Low dose buprenorphine. Try 0.25mg/day and tell me what happens with your depression.

Later on you can prepare a liquid solution to taper down in the microgram range from 250 to 200 to 150 to 100 to 50...you get the idea. You won't have any withdrawal syndrome kicking 50 micrograms of bupe.

Low dose bupe is being studied for treatment resistant depression and shows promise.

My own research has confirmed its antidepressant properties.

And JTT, I already know what you're going to reply, just fuck off with that. You're a teenager.

 

[justtakethat]

Low dose buprenorphine. Try 0.25mg/day and tell me what happens with your depression.

Later on you can prepare a liquid solution to taper down in the microgram range from 250 to 200 to 150 to 100 to 50...you get the idea. You won't have any withdrawal syndrome kicking 50 micrograms of bupe.

Low dose bupe is being studied for treatment resistant depression and shows promise.

My own research has confirmed its antidepressant properties.

And JTT, I already know what you're going to reply, just fuck off with that. You're a teenager.

Who gives a fuck about what my age has to do with it you stereotypical fuck

 

[Phil.McKeer]

It doesn't really, I just already know you're gonna come in with your "if you use any substance its a crutch you should just go cold turkey or you're an addict and will be on it for life" crap. Funny coming from a guy who ingests drugs on the regular, 'you hypocritical fuck'.

 

[simplescience6]

JTT, I accept your criticism and appreciate that you took the time to respond. I am grateful for opinions critical of bupe, I want to hear from both sides of the aisle. However, with respect to willpower, years ago I managed through a horrific period of buprenorphine withdrawal and remained opioid free for over five years. In that time I experienced a growing depression, which culminated in relapse. Willpower I can muster. I can eventually get back to where I was, opioid free, and depressed...that isn't where I want to be. I'm looking for input, from those with experience or knowledge, on the efficacy of using buprenorphine to treat depression, especially given my history. And JTT, while I appreciate your time here, and I do not mean to condescend, you haven't exactly contributed in that manner. A decade or more ago, prior to my recent experiences with chronic depression, my attitude was rather similar to yours.

Phil, thank you for the suggestion, I've been considering something similar to what you have described, water titration and all. I now understand that long slow tapers are the way to go with buprenorphine. Do you currently take low dose bupe for depression? Have you successfully tapered off in the past, in the manner you have suggested or otherwise?

 

[pooneilcorners]

While I think it's great if someone can make Kratom work, I found it didn't do a thing. As ### said, it seems a billion times weaker than subs. I can really empathize with you. I'm currently on subs for addiction, and although I feel completely normal (like I'm not on a drug), I don't suffer the anxiety and depression that I remember feeling many years ago before becoming habituated to opiates. For me, it seems like some kind of positive side effect of taking the drug. When I've tried to quit before, just like you, I couldn't sleep for weeks, felt horrible, and eventually just went back on the subs. I'm working with a new doc now that's doing a really slow taper, so we'll see what happens...

 

[justtakethat]

It doesn't really, I just already know you're gonna come in with your "if you use any substance its a crutch you should just go cold turkey or you're an addict and will be on it for life" crap. Funny coming from a guy who ingests drugs on the regular, 'you hypocritical fuck'.

Now your telling me what im going to say and my views? Lol using drugs is perfectly fine by me as long as there is willpower. There arw some drugs i dont really approve of but thats because of how bad they are like meth. Theres nothing wrong with using opioids or heroin or most drugs, but when you are to where you need it or you cant function thats when i think its too far. Good luck with your depression OP i know how shitty that can be.

 

[simplescience6]

Thanks for the post Po. Do you mind if I ask why you desire to discontinue the bupe, and from what dose you previously tried to jump?

 

[luvny]

I don't know if this is the right thread to throw in on, im in bupe maint after 10yrs in MMT. It's been better than the methadone in that I don't get fucked up, or add benzos etc...but, like a dumb ass addict I quit taking it about a wk ago in the midst of a amphetamines run...so decided that maybe I could grab an opiate high while I was at it. 6days later my arms are trashed from shooting dilaudid & opana. I want to start the Subs again bc this little relapse has sucked. Im scared of the precipitated wd. Last opiate use was 14hrs ago-IV Dilaudid- does anyone know if I'm ok to take a Sub now. I absolutely get the depression & black hole feeling. For me, I've kinda just accepted that without opiates or opiate maintenance, I don't feel normal. I need the maint, lesser of two evils. I can fuck shit up quick on opiates. As evidenced by the last wk. Didn't mean to take over your thread. I'm new to the site & desp seeking answers as well. It's always a personal decision, you know yourself better than anyone. Good luck...I so totally understand.

 

[justtakethat]

I don't know if this is the right thread to throw in on, im in bupe maint after 10yrs in MMT. It's been better than the methadone in that I don't get fucked up, or add benzos etc...but, like a dumb ass addict I quit taking it about a wk ago in the midst of a amphetamines run...so decided that maybe I could grab an opiate high while I was at it. 6days later my arms are trashed from shooting dilaudid & opana. I want to start the Subs again bc this little relapse has sucked. Im scared of the precipitated wd. Last opiate use was 14hrs ago-IV Dilaudid- does anyone know if I'm ok to take a Sub now. I absolutely get the depression & black hole feeling. For me, I've kinda just accepted that without opiates or opiate maintenance, I don't feel normal. I need the maint, lesser of two evils. I can fuck shit up quick on opiates. As evidenced by the last wk. Didn't mean to take over your thread. I'm new to the site & desp seeking answers as well. It's always a personal decision, you know yourself better than anyone. Good luck...I so totally understand.

You can start a new thread by the way. And after a while if not using any opiates you wi begin to feel normal again it just takes some mental strength.