Opioids The Cold Turkey vs Suboxone/Methadone Future Mega Thread of 2011 Remix

[lozgod]

O.k., let's try again. I apologize for those with short attention spans and hate big gigantic posts. I don't read them either so I will break it down in to pieces this time.

I've made a personal choice to get a family member involved with my journey off of opiates (well all drugs altogether including alcohol). I am a pain management patient and have the luxury of a large prescription of oxycodone. I won't say the exact amount to avoid dick sizing and to protect my anonymity. She is going to hold my medication and give me my daily amount. My current habit is around 300mgs of oxycodone a day or 1-2 bundles of non tar heroin daily. We are gonna try starting at 4 doses of 30mg oxycodone and drop 15mgs a month. May move it along a little quicker, gonna see how it goes. Once I hit 60 mgs a day and am comfortable, 15mg drops will have a bigger effect so will probably move to 5-10mg step downs from there.

I do not need 300mgs to not be sick, it is the amount I take to get hi (barely hi, the getting fucked up days are long gone by). It is my abuse dose.

I told my heroin dealers don't sell to me. Not that'd listen but it can't hurt to try.

The family member has 2 assets. One is she lives very close by and two is she will know when I am bullshitting her and will stick to the plan even when I do not want to.

 

[lozgod]

Now to the "why" of my choice to an oxycodone taper then cold turkey WD vs going on methadone or suboxone and some info on the options.

For those unfamiliar those are the three primary ways people in the US get off of their opiate DOC.

Cold Turkey - Quitting whether it is after tapering down to soften the landing or sudden stoppage of using. This can be assisted with comfort medications. These include clonidine, benzo's for sleep and anxiety, RLS (restless leg syndrome) medications like requip, immodium aka loperamide (anti-diarrhea dose not avoiding withdrawal dose), calming herbs, and there is something called the Thomas recipe which includes some of the above plus certain aminos and vitamins for lethargy and overall healthy recovery.

Suboxone/Subutex aka buprenorphine (suboxone includes nalexone to avoid IV abuse) - A partial opioid agonist that is also a K antagonist giving it anti-depressant properties. The usual treatment can last on average 8-18 months long with extremes on both ends for short tapers of 3-21 days to lifetime maintenance. There is an induction phase, stabilization phase, maintenance phase, and detox phase.

Induction is usually in the physicians office in opiate withdrawal to get patient starting treatment, and to make sure bupe isn't going to cause precipitated withdrawals (PW). A unique thing about bupe is it can act as an antagonist when opiates are present in the brain. It has a higher affinity to the receptors than most and will displace whatever opiates are attached and act as an antagonist and throw the patient in to a very uncomfortable withdrawal that in my experience causes severe panic attacks, projectile vomiting, and the normal withdrawal symptoms but intensified. In my experience it lasts about 4-6 hours. Some people report longer, some shorter, but the best way to avoid is waiting 24-48 hours after last usage of short acting instant release opiates/opioids and 72-96 hours for longer acting and extended release opiates/opioids. My PW was from using methadone. I waited 3 days and felt slight WD symptoms and was getting inpatient waiting for WD to start so I took 16mgs of suboxone and wished that I didn't for the next 6 hours. Once all goes well with induction or the finality of PW comes the next phase.

Stabilization is determining what dosage will keep the patient from being uncomfortable and able to function normally. This can be from 8-32mgs on average. Most people will hold at 8 but the theory of higher dosages is will help with cravings of DOC. Feedback seems to agree with this. Bupe has a "ceiling effect" that will not allow the user to increase the dosage and get more effect from it. This ceiling dosage is around 32mgs.

Maintenance phase is reached when the patient is doing well on a steady dose. This can last a few months or life. It is the doctor/patient's choice.

Detox phase is a gradual taper, the lowering of the maintenance dosage down to zero over time. Once 0mgs is reached it is known as "jumping". Jumping can occur from 0.125mgs up to 1mg. The lower the better. The dosage can also be combined with gaps in time between doses. Some people reach their lowest planned dosage then start spacing them out 2-3 days.

 

[lozgod]

After jumping there will be withdrawal symptoms. They are said to be milder than full agonists but tend to last longer. There are many testimonials of suboxone WD online. From my research people agree they are milder but if suboxone is used long term (1+ years) before jumping there is a long lasting depression and anxiety issue. Some people report it to last as long as 6+ months. In addition to that I have come across a lot of complaints of severe lethargy lasting 90+ days. In addition to the withdrawal issues I have read instances of side effects like lack of motivation and sex drive while using suboxone that goes away after using it stops.

The other option is methadone maintenance/detox. This can last 21 days to life. The phases of methadone are similar to suboxone but methadone is a full agonist, can get you high at a high enough dose, and both drugs at high enough doses will block the high of most other opiates/opioids. There are similar issues with long term effects after initial acute withdrawal is over that come with suboxone. They are also long lasting. Another post acute withdrawal symptom is an inability to get a full 8 hours sleep for a period of about 30-90 days. I have several friends on methadone and they tell me methadone does not affect their sex drive as reports I have found of suboxone users. Usually methadone is distributed to the patients daily at methadone clinics, whereas suboxone is given as a take home medication.

My decision to not go the methadone or suboxone road is I do not want to deal with the long drawn out withdrawals at the end, suboxone being a partial agonist concerns me. The brain is made to function on full agonists. There are no studies on how long term use of a partial agonist affects the functioning of the brain to my knowledge. If I had to chose between the two I would pick methadone because it is a full agonist and pick it solely for that reason.

Going with a oxycodone taper will keep my withdrawal as short as possible, it will keep the PAWS (post acute withdrawal syndrome) as short as possible, and it is a full agonist.

 

[lozgod]

The cons are it is one of my drugs of choice. That is why I had to get someone else involved. Addiction is not about will power. Addiction towers over will power. Addiction turns girls from good families with good values in to prostitutes, makes people go in to neighborhoods known for murders to get their drugs, turns millionaires in to broke junkies, etc etc. Addiction also isn't the same as dependence. I know I am an addict. Addiction is defined in Narcotics Anonymous as a physical, mental, and spiritual disease. Mental is obsession, the constant thoughts of using, physical is compulsion. Once an addict begins using they can not stop. It is said one is too many and 1000 is never enough, and spiritually it results in total self centeredness. People only are concerned about themselves and their drug use. They will lie, cheat, and steal from people that trust and love them to get hi.

Dependence is when a non addict becomes physically dependant on a drug due to it's withdrawal. Long term use of opiates will make a person physically dependant but they may not be an addict. If given the opportunity to get drugs by stealing $20 from their loved one or going in to withdrawal, an addict will steal the money, a person physically dependant will go in to withdrawal without considering stealing from their loved one.

Addicts need some kind of treatment be it 12 step meetings, therapy, religious counseling, whatever. They can not go it alone in most cases. Those that do and are successful run the risk of relapse because they never get the opportunity to address the issues that had them turn to drugs in the first place. Most but not all addicts begin using drugs to run or hide from some kind of pain. People that are dependant are usually introduced to drugs by a doctor. I intend on going to NA once I get clean. Whether or not one is clean while on suboxone or methadone can be debated but in my personal opinion when one is using drugs, be it prescribed by a doctor or copped off the street they are using. Some believe they are not getting hi from suboxone and are following a doctors regimen so they are therefore clean. I myself will not tell that person they are not clean. I feel that is a personal choice one has to make for themselves.

Once I jump from the oxycodone I will start attending meetings and take comfort meds with the exception of benzo's to avoid the risk of making them my new DOC.

 

[lozgod]

I've said a lot of negative things about suboxone and methadone but I want to tell the other side of the story. I have seen those things turn junkies in to functional members of society and allow them to get jobs, reunite with their families, and pretty much return to a lifestyle that is lived by non addicts.

I've cold turkeyed from oxycodone once before. The acute symptoms lasted about 4 days for the worse of them. They included restless arms and legs, huge emotional swings, hopeful one minute, felt doomed the next, very little sleep, just naps here and there, days 3 and 4 were unexplainable as far as my mind state. After 4 days with no sleep I got pretty weird. I had to force myself to drink water and food wasn't an option with the vomiting and the lack of appetite. I just made sure I stayed hydrated. PAWS wasn't difficult for long. I did have a phase of deep deppression but it started getting better a couple weeks after it set in and then I started feeling brand new. No plan for continued recovery and having to deal with an emotional situation led to my relapse. Getting clean is not the harder part. The harder part is staying that way. This post is primarily about getting clean though.

 

[donnie080208]

@lozgod imo methadone/subs are the best option for a serious opiate addict(is there another). the chances of staying clean after cold turkey are slim to none ime. even after coming of years of methadone with few slips i believe the stats are 95% are back on H within a year.
oxys arent available over here so not sure how bad there wds are personally,
also i believe how sucessful someone is going to be after detox is down to what mental health problems they had before their addiction took hold. this is why i think professional help like shrinks/pych doctors are better than N.A. in the short term after detoxing. seen a documentry about womens only,meth addiction rehab where the women running it said 85% of patients victims of sexual/physical abuse. these peoples first port of call shouldnt be N.A. 12 steps meetings imo telling them their spiritually deseased

 

[lozgod]

@lozgod imo methadone/subs are the best option for a serious opiate addict(is there another). the chances of staying clean after cold turkey are slim to none ime. even after coming of years of methadone with few slips i believe the stats are 95% are back on H within a year.
oxys arent available over here so not sure how bad there wds are personally,
also i believe how sucessful someone is going to be after detox is down to what mental health problems they had before their addiction took hold. this is why i think professional help like shrinks/pych doctors are better than N.A. in the short term after detoxing. seen a documentry about womens only,meth addiction rehab where the women running it said 85% of patients victims of sexual/physical abuse. these peoples first port of call shouldnt be N.A. 12 steps meetings imo telling them their spiritually deseased

Doesn't have to be NA but any help after a detox will be the key to staying clean, not the manner of detox. If you cold turkeyed and immediately started intensive therapy, be it NA, phsyciatry, etc. you stand the best chance of staying clean. I've been to rehab and outpatient therapy before and they all pushed 12 step meetings alongside outpatient therapy. I litterally met 1000s of recovering addicts in NA with decades clean from heroin use that got clean before suboxone was thought of as a therapy for opaite use. Tens of thousands of Vietnam vets that were addicted overseas got clean once they came home and never used again. America has turned in to a qucik fix with a pill society. We are a nation of trying to find the easy way out people. There are plenty of examples of people that quit cold turkey and stayed clean. Relatively speaking suboxone is a new drug on the scene. Methadone has been around for a while but the withdrawal from methadone is longer lasting and can be worse than regular opiate withdrawal.

Suboxone and methadone are just delaying the inevitable. The argument they allow you to function without your drug of choice is a good one but it is still using, just using under a controlled regimine. Eventually you have to cold turkey detox from them as well. So you aren't staying clean, you are substituting. The key to staying clean is what you do after withdrawal. Therapy after cold turkey shouldn't be any less effective than therapy after going on suboxone or methadone. If anything it should be more effective because you are truly clean and have the character building aspect of not taking the easier route.

 

[villian]

Suboxone and methadone are just delaying the inevitable. The argument they allow you to function without your drug of choice is a good one but it is still using, just using under a controlled regimine.

Maybe thats the point? Drug use isn't black and white. You don't have to choose between between a dopefiend or being clean. Some people aren't ready to be 100% drug free but do want to leave the illegal opiate lifestyle.

For many people having a crutch like bupe or methadone allows them the time to get their life in order before deciding to jump off.

Drug use is a very individualized thing though and everyone is different. It is up to the user to make the decision what works best for them.. be it a cold turkey a taper or maintenance.

 

[lozgod]

Maybe thats the point? Drug use isn't black and white. You don't have to choose between between a dopefiend or being clean. Some people aren't ready to be 100% drug free but do want to leave the illegal opiate lifestyle.

For many people having a crutch like bupe or methadone allows them the time to get their life in order before deciding to jump off.

Drug use is a very individualized thing though and everyone is different. It is up to the user to make the decision what works best for them.. be it a cold turkey a taper or maintenance.

Exactly the point of starting this thread. Wanted to offer both sides of the argument. It isn't a one size fits all thing, but I get tired of seeing suboxone or methadone pushed as the only option. Wanted to open the conversation up to the cold turkey option.

 

[NeighborhoodThreat]

^^I like this idea, should be a sticky!

 

[Cane2theLeft]

^if you want the thread to be read and discussed, you don't want it to be a sticky... they have been tried for years for important HR topics, forum news, guidelines, etc. and it doesn't matter. By and large, people ignore stickies.

 

[lozgod]

Yeah I rarely read the BL stickies myself. This is one board that they get ignored for the most part. On most boards people turn to them first but this is the exception.

 

[donnie080208]

LOZGOD " Suboxone and methadone are just delaying the inevitable."


THE INEVITABLE WHAT? homelessness,death,jail far better on these then the aforementined possible outcomes. all the available stats show maintenance is the best way and most likely option to improve an addicts life. still addicted when on these medicines? so bloody what? with respect, N.A. and the 12 steps dont supply any sucess rate stats and are at best ,slightly helpful companionship and at worst , more harmful than to addict than going it alone after detoxing physically.

 

[lozgod]

LOZGOD " Suboxone and methadone are just delaying the inevitable."


THE INEVITABLE WHAT? homelessness,death,jail far better on these then the aforementined possible outcomes. all the available stats show maintenance is the best way and most likely option to improve an addicts life. still addicted when on these medicines? so bloody what? with respect, N.A. and the 12 steps dont supply any sucess rate stats and are at best ,slightly helpful companionship and at worst , more harmful than to addict than going it alone after detoxing physically.

Inevitable withdrawal. A way longer lasting WD and PAWS at that. A cold turkey detox will also stop the aforementioned outcomes if it is successful. What do you think people did before suboxone? Do you think they all went on methadone or continued using? Do you not realize people have been clean for 100s of years without subuxone? The easier softer way robs people of the experience of seeing the consequences of their actions. I know alot of people that keep using because they know they can just get back on suboxone when it gets bad. They don't get to experience the consequences. They got the magic pill to allow them to keep using.

Also I said ANY kind of therapy after detoxing, not just NA. Think people are a little too focused on that. NA being an anonymous program that does not track results, that answer will never be known but I know plenty of people with 1-5-10-20+ years clean from heroin in NA. Also if you ever been to rehab (in the USA at least) most push attending 12 step meetings after completion of rehab along side of their outpatient program. Not to mention most rehabs design their ciricullum based on the 12 steps. NA is not just attending meetings. The program is in the 12 steps which have very profound effects in people's lives. Only someone that has witnessed or experienced this can understand. Most people that have anti-NA or anti-AA sentiment are still using (using including suboxone and methadone, maybe iof they tried the steps they wouldn't need to keep using) Also not providing stats doesn't mean it works any less than other methods. It could work better. You don't know, there are no stats to say either way. Companionship with people that know exactly how you feel and are going through seems a lot more beneficial IMO than seeing one person that never had the same excperience, just plaques on their wall that they got being taught by professors that have no idea how or what we feel. But again. I said after detoxing getting some kind of help be it professional, NA, religous, whatever. DOESN'T HAVE TO BE NA.

 

[MaleNurse/Addict]

My only concern with the Suboxone
Program, here in KY anyways. Is that it
Is outrageously priced and the doctors offer noooo encouragement to taper individuals off.
Must visit the office weekly and pay for the first two months (once
Monthly after)--325$ cash/visit and nearly all
Insurances recently decided to no longer pay
For suboxone Rx so one must pay 7-12$/pill for their medication

As an addict in the medical field
I have a drastically different viewpoint I feel that doctors are poorly educated on dosing...
i.e. Dosing 32mg/daily to an addict that does ONLY 40mg/oxy/daily
From much personal experience on my "sick days" 2mg of Sub lasts 24hr
For myself and my habit Is closer to 4 opana 40s daily or 4-500 Oscar

Is this simple naieve overprescription? Or intentional to ensure the patient must
Return and pay
Cash for services for years potentially?

I don't mean to insinuate, just curious
Of others feelings

 

[MaleNurse/Addict]

Btw, the latest number, according to a Nat Geo Documentary, only 5% of opiate addicts will remain clean for the entirety of their lives, regardless of method of cessation

I always say that it's necessary to
Go out the hard way and suffer cold turkey
In order to appreciate
Your victory as opposed to taking a pill and tapering down....unfortunately I went
Cold turkey from my current tolerance twice in two years and I'm
Back again so....my theory must be shot