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Adjusting to suboxone

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Ram2358

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Oct 16, 2017
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So i have decided to try to kick heroin...again...but this time different than before. I was doing <snip/> of heroin. Like most i started snorting oxycodone 30mg "roxies" and progressed to heroin as the pills became harder and harder to find and more and more expensive. When i started H i snorted it just like i did my roxies and opanas but after a while i was using IV. i have been addicted to opiates since 2009. Sure ive tried to quit before or had to go a few days with nothing waiting on my next paycheck so ive suffered more than my fair share of withdrawal symptoms.
Last Wednesday i had my appointment at my local suboxone clinic. Great place i guess. People were very nice they offer counseling as part of their program. They dont force AA or NA meetings as ive heard of some doing but they do encourage it. So all that said they have put me on two 8mg suboxone pills a day. Thank god its the pills the films are so God awful with that orange flavor they try to put in it.
So here it is Sunday. Day 4 of no heroin. No nothing only my subs as prescribed. While i cant say ive experianced no withdrawals its a far cry from the going cold turkey. My biggest issue and i guess what im looking for a little feedback on is my insomnia. It is horrible. Even going cold turkey before i could knock myself out with enough advil pm atleast for a few hours. I took 5 lastnight only to stay up binge watching Trailer Park Boys on Netflix. All night. No sleep. In the last 4 days ive maybe slept 12 hours total. Is this the suboxone? Will my body adjust over time? As i go longer without the heroin will this subside? I also have the RLS but nothing like the crawling out of my skin feeling. Just a constant bounce in my legs. Has anybody else had any issues adjusting to suboxone? I wake up for work at 6am and i take my first sub then. I take my second around 2pm. I tried to adjust my dose so i take my second later in the night but thats when i stayed up all night long. Sure ive taken subs before but since there was never any "high" or "nod" associated with it i never really went that route. Any feedback,advice or similar experiences would be greatly appreciated.
 
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Hi and congrats for stopping heroin abuse!

In my opinion taking Suboxone in the evening will cause insomnia and when I took it as a one dose when I woke up I could avoid insomnia after few weeks from starting Suboxone.

RLS disappeared completely in a month and so did last of my sleep issues.

I abused roughly 250mg oxycodone sometimes even twice a day when I started Suboxone aided ORT.
 
Hey, Ram. First off, congrats and awesome work on deciding/acting to get off H.

One point of clarification: it sounds like your plan is to be on the subs for a while, in support of your recovery...am I right about that? (Things would be different if you planned just to use them to 'step down' and help manage WDs temporarily).

Assuming I've interpreted the situation right, a few thoughts come to mind. The short answer is that in theory the subs should remove WD symptoms completely. If they aren't they question becomes, why not?

My first thought is, are you using your suboxone tabs properly? i.e. Are you letting them dissolve under your tongue completely, not swallowing them? Quite a lot of folks swallow the pills, which will lead them to have negligible effects at best. I suspect this probably isn't the issue, but if so, it's easy to solve!

If you are taking them correctly, I guess my next thought would be that you might need a higher dose. 16 mg/day is, for many people a sort-of medium/high dose. But everyone is different. And it does sound like your habit had trained your body to rely on a pretty high amount of opioids. It could simply be that for now you need a bit more suboxone in your regimen. I was on 24 mg/day for a while, and then worked my way down...could be worth a try.

Another possibility is that the WD symptoms you're feeling are at least partly psychosomatic. You're making a big change in your life; it's stressful. It's certainly possible that this stress could impact sleep and make you feel ill at ease.

If none of these issues brings relief, you might consider another ORT medication such as methadone. For some people, especially folks coming off a long-term, high-dose habit, buprenorphine just doesn't cut it, and things like methadone can be more helpful. However, in my experience, this issue typically presents itself by buprenorphine being unable to help control cravings...less so when it comes to managing acute WD symptoms.

With all that said, your symptoms surely will improve with time away from opioid abuse. But it really sounds like the suboxone is helping you, just not quite enough, so I'd give yourself every advantage in your recovery and see if you can dial things in so it's helping as much as possible.

Please let me know if any of this either rings true or raises other questions.

Again, congrats, man. You're doing a great thing here. <3
 
SIMCO:
Thank you for your response and advice. Yes i let the subs dissolve completely...as bad as that is...and no i dont want to be on them long term. Atleast not years as ive read about some people doing. My goal is to get clean. I know some feel that being on a suboxone maintenance program is not "clean" well theres no needle in my arm and empty wallet in my pocket today so its a big step up for me. I plan to discuss how long their program lasts. This is my first time at a sub. Clinic. Maybe im being naive but i would imagine they start stepping you down to get off the subs to right? Certianly that doesnt take years. I go back to the clinic on the 21st to discuss how the medication is helping me. Im going to discuss my issues with them. If im still experiencing them. Maybe they up my dose. Im personally scared of methodone...just the horror stories ive heard of month long withdrawl symptoms....and my work schedule would not allow me to report to the methodone clinic everyday as the one and only clinic in my city wants clients to do. Thank you some much again for your uplifting and informative response.
 
Mr. Root thank you for your response as well and i was thinking this should clear up with time. Its only been 4 days since i put the needle down...im sure by a month this will not be an issue anymore.
 
6 days no heroin! The RLS is still there but not as bad the insomnia has improved but still present but overall i feel awesome
 
Ram that's great. Glad the WD symptoms are improving. For me, it took a few days to a week to feel 100%, even better than that. As simco stated, some people need more, some people need less, and for some people suboxone is just not for them. But it sounds like it's working for you. Each symptom that is eliminated will make you feel that much better and will snowball into you feeling much much better. I've never actually been to a sub doctor, always obtained illegally, I guess b/c I didn't want to be on them long term. Anyway, I've heard many different experiences with sub clinics/drs, some are great and caring and others are just there for the money. I would let them know you don't want long term treatment and hear what they have to say. Keep us updated.
 
Ram,

Obviously how long you use subs is totally up to you (and to some extent your doctor). I don't mean to pressure you or anything, but I would encourage you to consider staying on the subs for a while. In terms of long-term recovery, the research is pretty clear that suboxone helps the most when people remain on it for at least a couple years. I totally understand the urge to be completely free of opioids. But if you find that the subs help you survive cravings and other stumbling blocks, keep in mind that there is very little down side to staying on them. Medium- to long-term use of buprenorphine for opioid use disorder has (for many people) a stabilizing effect that allows folks to rebuild a healthy lifestyle.

OK, sermon over...it's of course your call completely.

Meanwhile, how are you feeling? Have the insomnia and RLS subsided any?
 
Insomnia has gotten better the RLS is there but nothing like before so yes gotten much better. The last time i got clean i put together 14 days. By day 5 the real excruciating WD symptoms had subsided but the cravings is what killed me. It was all i could think about until i finally talked myself into a "reward" and that was it i was right back on it. This time is alot different. I think i will stay on the subs for awhile. Its alot better than the alternatives...i am finding i have more and more energy each day. The dark circles under my eyes have almost gone away. im going to stick with it for a while. I slept almost fine lastnight.1130-500...i need to give it more time. Like the saying goes,it took me awhile to get to where i was it will take me awhile to get better
 
Ram2358 I'm happy that you continue to move in the right direction. I read your initial posts where you noted that some withdrawal symptoms remained, and I hoped you'd not throw in the towel prematurely. I've gone through the induction process more times than I care to admit. I know for a fact that it takes time for the body to adjust to buprenorphine. I think your decision to "stay on the subs for awhile" is prudent. I agree with Simco: there is very little downside to the buprenorphine. Also, being accountable to the supportive staff at the clinic is very helpful, based on years of personal experience. I always do better when using bupe under professional supervision vs. obtaining the medication illicitly and going it alone.
Finally, in my personal experience, with respect to the induction process and the ability of my body to adjust to bupe comfortably after a period of time using heroin, it's never as easy as the time prior.
Keep us posted.
 
Didn?t have the same symptoms you?re describing, but it took months for my body to adjust to the subs! I had a decent heroin tolerance, so I thought for sure I wouldn?t feel anything from suboxone, definitely not a nod or a high, but also no other side effects either. Fuck, I was so wrong. Suboxone wrecked havoc on my body. SEVERE loss of appetite (for a month all I could stomach was ice cream and I lost ten pounds off an already junkie-thin frame), SEVERE headaches, especially in the morning, bad muscle aches, the most painful hiccups in the world, constipation (as bad as heroin, imo), nausea. It took a while before my body started going with it. If you?re having bad insomnia from suboxone, I wouldn?t be surprised at all. I?m glad suboxone is around and all, because without it I?d probably be using again, but it is a hard med to get used to.
 
Someone Who Is Me said:
but it took months for my body to adjust to the subs! ... Suboxone wrecked havoc on my body ... It took a while before my body started going with it ... but it is a hard med to get used to.
Click to expand...

Wow SWIM. Sorry to read about how difficult the transition was for you. The first time I ever used suboxone I did so properly (as I assume you did): per doctor's specific instruction, waiting long enough before induction so as to avoid precipitated withdrawals, and didn't use any other opiate simultaneously. I recall an almost seamless transition except slight difficulty falling asleep for a few nights. Also, for the first few days or maybe a week, I would awaken drenched in sweat. I recall having to change my clothes entirely during the middle of the night. The sweats subsided over time. I had no other side effects that I recall.

I think our experiences demonstrate that the transition can vary widely from person to person. One common theme however, many if not most people find suboxone to be incredibly helpful, despite the potential side effects.

Ram2358 I hope you are still moving in the right direction. By the way, you noted that the clinic does not "force AA or NA meetings ... but they do encourage it." Are you considering attending?
 
Oh yeah, those night sweats! I forgot about them. My night sweats were so severe in rehab that I actually got super dehydrated. The place where I went treated eating disorders as well as addiction, and even though I don't have an eating disorder at all, they accused me of throwing up and put me on "bathroom restriction" because my weekly blood work showed such bad dehydration. It took me almost a week to convince them that it was due solely to night sweats from the subs! Basically, I just wanted them to quit drawing my blood. That shit fucks with your head when you're coming off dope, haha 8(.

I'm glad you didn't have the same experience as I did. It seems like a lot of people have very smooth transitions onto subs. The first time I ever took them, it was years ago and it was "recreational" (I had a MUCH lower tolerance then.), but I didn't have any of these problems at that time because it was a one-time thing. Once I started taking them as prescribed, after a crippling heroin addiction and with a heroin-level tolerance, all of these problems started. I thought at the time that maybe they were due to protracted withdrawals, rather than the subs, which I guess could be true. Either way, I totally adjusted, and it was 100% worth it to go through that rough adjustment because my cravings simply are not manageable without some sort of opiate replacement therapy. Suboxone has a lot of benefit over methadone too, from what I hear.

So OP, don't let my bitching and whining scare you away from subs if you think they're right for you. My experience, I think, is uncommon, and oldhippytony is right, everyone reacts very differently. Even with the harshest of adjustment symptoms in mind, I'd still recommend subs over unmedicated heroin cravings. Nausea and night sweats will not threaten your recovery the way the cravings will.
 
Hi, id like to give a lil info on my experience. I first tried snorting, taking more then prescribed, and even plugging. Everything short of iv ing my subs. To tell you the truth, i found that spreading the medicine around your mouth and keeping it there as long as possible helps it work the best for me. I have been on it for 3 weeks now and went from absolutely no sleep to sleeping like a baby again. Thats the one thing i hated about withdrawals. Insomnia. The crawling out of my skin part is also gone, whick is great.
 
Using Listerine or some kind of ethanol mouth wash before taking buprenorphine sublingually can make a big difference in terms of effectiveness.
 
Really? What does that do? I've always heard that drinking something first helps them dissolve more effectively. I've never heard about Listerine, though.
 
I'm glad it works for you. If it wasn't for cost and pharmacy hassles I would think the best thing to do for people like us is stay on it forever. But I make the mistake of lying to myself that I wasn't doctor shopping and was too scared to try to get back on it so I just stopped.

Just please don't make the mistake I did by thinking that just because the intrinsic action is low (but the affinity is high) that this stuff is easy to get off of. It seemed worse than methadone to get off of even though when I did stop the methadone, I started the bupe and it was 5 years ago now so the memory of how bad it was may be receding. I've used kratom, tianeptine and benzo's to ease the bupe withdrawal which I think has helped to some extent. I think the truth really is I just can't accept life on life's terms and have mind fucked myself over too many decades to mention into believing that I need something to get by.

I tried to find an addiction psychiatrist at the local university but they said they didn't handle addiction issues and referred me to this place that turned out to be a huge methadone/buprenorphine clinic. All kinds of people that looked dicey and ill were there (like me only much younger, LoL) I don't necessarily want to get back on bupe so there was nothing they could offer me. I have an appointment for an addiction psychiatrist in early april on a self pay basis since none of the ones listed on my health insurance were available. I hope they can do something for me because this treating myself makes me feel untethered. I told them I wanted to be treated for PAWS but didn't want to tell the phone receptionist I was self medicating although I will tell the doctor if I live long enough to make the appointment.
 
I have been on and off methadone for SEVERAL years and cant imagine ANYthing being that painful to get off of
 
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