Thoughts on naltrexone implant after suboxone?

[Crankinit]

Has anyone tried this and found it successful? I'm working on tapering off my suboxone after 3 & 1/2 years because I'm sick of the side effects, sick of going to the chemist twice a week, and quite frankly just want to know what it feels like to not have opioids in my system after all this time. I also know that waiting longer is just going to make jumping off worse, so I decided to bite the bullet.

The problem is that I'm not certain of my ability to avoid getting high again once the suboxone isn't in the way. I spent most of the first year on the program dropping off the subs every week or two to get high for a few days, and even after I stopped that I got high every 6 months or so for the next 18 months. It's now been another 18 months and I've had no conscious desire to get high strong enough to motivate me to take a break from my subs since the last time - in fact the thought of going through 24+ hours of withdrawal at either end of the high makes me shudder.

Psychologically I'm also in a better place and I have a lot more going for me in my life that puts me off the idea of going back to my old lifestyle of nothing but drugs, and I'm strongly motivated to move on with my life. That said, I still get hit with the occasional intense cravings - messages from old contacts, being offered on the odd occasion I still go out, even small stuff like seeing pill boxes or reading articles about opiates.

So I'm thinking the naltrexone might take the place of the suboxone in preventing the spur of the moment relapses which I've proven I'm not immune to. I went out of my way just a few weeks ago to buy some K to inject because I was in a bit of a slump, and 3 months or so ago I went to a party with a friend and ended up smoking meth when I was just there to buy some GHB (granted, those are the only times I've gotten high at all in the last 9 months, and I don't even drink or smoke anymore) - if these substances can tempt me, then I don't doubt that if I found myself with a bag of H or oxys in front of me and the ability to get high immediately, old instincts would override conscious decision making in an instant and I'd go into autopilot.

So yeah, I'm curious about people's experience with naltrexone implants, especially after prolonged maintenance, and whether they think it would help in my particular situation. I'm thinking it would be a nice way to adjust to life without anything tickling my opioid receptors at all without risking throwing away all the hard work because someone busts out a bag of H when I'm at their house watching movies (as happened the other week).

Thanks

 

[*Venus*]

I am curious about it too many ppl I know said it was painful but otherwise fine and believed it kept 'em clean

 

[Jabberwocky]

Buy the tablets first and then work out if it's an option. However Naltrexone is quite expensive in pill form. Here in Australia it's bout $140 for 24 tablets. I was going to use this for my alcoholism but never bothered in the end when I saw how expensive it was.

 

[Crankinit]

Yikes. Of course I have no idea how much the implant costs, it could be more, and then there's the issue of finding a doctor willing to put it in. I tried finding one who would be willing to give me a testosterone implant to replace the patches I use right now (anyone who says suboxone can't decrease testosterone production can fuck themselves ) and none of them were willing to go to the effort. GP's are a lazy bunch when it comes to anything other than handing out flu shots and antibiotics.

I thought about the tablets, but figured the implant would be a better option for a whole bunch of reasons - less messing around (once every 3 months I think it is, as opposed to filling scripts and taking pills every day) and less temptation (not sure what the duration of the pills is, but it seems like the implant would nip any thoughts about skipping doses in the bud). You're probably right that trying the tablet for at least a few days before letting them put an implant in me would be a good idea though, just to get a feel for the effects. If it makes me horribly sick or depressed or something I don't want to have to wait a week or whatever for the doctor to take it out.

 

[jammin83]

I used to get the vivitrol shot. I was on it for about seven months. Didn't do jack for me except made me count down the days until I could get high and I didn't even have a habit when I was on it. It jacked up my anxiety and made me feel weird, esp. the first half of the month. I would be wary of any implant or long lasting shot honestly. I don't trust that stuff to be dosed evenly and having that much of any substance in your body at one time, yikes. I really don't think that's very healthy or good for you. Look at the huge mess with some of the birth control implants. Things are trouble man.

If you really don't want to use opiates then just be stick to your guns. I know that first year is hard but every day you go without it that pleasurable memory goes away with time. It gets easier and easier. If you want to try naltrexone definitely try the pills first to see how you react. I hated the stuff. Good luck man I hope you find the freedom you are looking for.

 

[Captain.Heroin]

Just quit. Naltrexone for suboxone use sounds like overkill.

 

[Crankinit]

Just quit. Naltrexone for suboxone use sounds like overkill.

I think you missed my point. I'm not worried about the suboxone, I'm worried about the constantly available heroin/pharms once I don't have suboxone to make getting high more effort than it's worth. Given my history, it's not an unreasonable concern.

 

[Niko290]

OK... Here goes nothing.... This is MY personal experience so take it with a grain of salt. Please do not use this report alone to make your decision. But instead a bullet point on your list of pro's and con's....


Relevant Background Information:
Male, 25 years old, heroin addiction began 5 years ago. There was a stint of 12-18 months sobriety between the beginning and now (but it was more along the lines of being a 'dry drunk'). Been to rehab/(supervised)detox's maybe a dozen times, but specifically for dope 2-3(?) times. Have been scripted Naltrexone pills in the past when I was heavy into drinking. But found it way to easy to say, 'fuck it' and not take them when I gave into my desires. This will be relevant later, I have been on adderall/vyvanse for 4-5 years.

My last binge on the junk lasted about 2.5-3 years. In June/July of 2014 me and my gf were tired of it and sick of being sick. So (in order to keep things short I'll leave out unnecessary details) I went to my psychiatrist - been seeing him for about 8 years at the time so knows my entire history - to get on subs. I ended up getting on them and was on them up until this past May of 2015. However, I would only take them in sparingly times of conviction to recovery and to help out in times of being dope-sick. And even then I would always split my script with my gf because she didn't have a psychiatrist and this was still a hugely guarded secret of ours obviously.

Well, since last June/July to this June of 2015. The secrets no longer a secret, our addiction led us to a life of crime, caused us to move back in with our parents, and I was faced with the ultimate ultimatum. I could either 1. Go to Mexico and get the Ibogaine treatment, 2. Get the Naltrexone Implant, or 3. Me and my gf would go to prison and do serious time. (We were both already on felony probation and violating that alone we were looking at 3-6 years, not including the additional felonies committed to keep up our habit). Well, I didn't want to have my gf to be in prison so #3 was out. I had completely drained my family's savings and #1 was more expensive than #2 and I already felt guilty enough so I had no choice but to get the implant.

The Process:
The place I go to uses it both for alcohol and opiate addiction. After all the initial meetings and stuff they make sure you're at least 7-10 days clean of all opiates. Even Subs. After you claim to be 7-10 days clean they'll urine test you. I showed a faint line for subs (I was jonesin one day a few days before and took one). We talked it over and decided to move on to the next step: The Naltrexone Challenge.

The challenge is where they titrate you on an oral solution of Naltrexone over the course of three hours. This is to really make sure you're clean. If the implant is put in with opie's still in your system you will go through rapid withdrawal which is something they do not want you to go through. Anyway, they start at 1mg Naltrexone solution, wait a certain amount of time, then 2mg, then 4mg, 6mg... ending testing dose is 15mg. If no withdrawal symptoms are reported your appointment for the BIG DAY is made within 48-72hrs. And you're kept on naltrexone pills until then.

The actual implantation is done by a third-party doctor. It's relatively painless, finished in under an hour (from walking in to walking out), and is done under local anesthetic.

This particular place I go to (not the dr who implants the actual things) uses 2 pellets. They said the average length it takes to completely metabolize is 6-12 months, with the shortest person testing clean for naltrexone after 5 months and the longest I think they said was 15 months.

Follow Up:
I don't want to use the companies name so I'll just keep referring to them as "this place". Well this place is pretty good at following up with you I must admit. They give you meds before the procedure to help with wd's and after to help with post-op symptoms. They also make themselves available with their personal cell number to text/call whenever. And they also give 14 Skype therapy sessions included with the price, which is ~$26,000 but depending on insurance comes out to 4-6k out of pocket. Payment plans available!! Anyway, the idea behind the Skype therapy is to keep you in "your world" while learning to be sober. Rather than the unrealistic world a rehab facility provides... makes sense.

Now.... MY feelings on this shit...
I had the implant put in on July 1st. So just over 3 weeks. The following are what I personally experienced/am experiencing: obvious post-op pain/cramps, SEVERE depression, suicidal idealization/attempt(s), abdominal cramps/pain - severe stabbing feeling at times, loss of appetite/thirst, weight loss, nasty "hungover" feeling EVERY FUCKING MORNING... diarhhea (even after days of no eating/drinking), nausea, and something to do with elevated liver enzymes. Actually, looking at this list now only the post-op cramps are gone. Everything is still present. Before I was implanted I was told the cravings would go away and "some people may experience slight abdominal discomfort for a few days." I have a history of severe depression (diagnosed with Major Depression) and have had MULTIPLE suicide attempts which have landed me in the hospital. After I was implanted I was told a longer list of symptoms which includes depression, suicide idealization etc... Call me crazy but don't you think it's just a LITTLE bit important to advise someone with a long history and attempts of suicide/depression to tell them there is a chance I could experience it?????

Moving on, they are confused by the loss of appetite and diarrhea. They said it should have gone away after a few days and there is no reason for it to last this long. And if I were allergic to the Naltrexone there would be inflammation and other allergic reactions around the implant site. So now I have to go give a stool sample.... shit! I told them I want it out and go on and on about why and how its making me feel. Basically, I was told to suck it up and start exercising to help with the depression, find a new psychiatrist (whooole other story), and get on a anti-depressant. And as for the pain/diarrhea/nausea... just force myself to eat ("before I take my adderall" - Adderall never affected my eating LIKE THIS before). And manage the symptoms as necessary.

These fucking guys... I think they genuinely care but I don't think they take me seriously and think I am being a little bitch.

I'm still waiting on my most recent blood test results to see how my liver is doing. I've gone as far as writing a suicide note and tried to hang myself. But its a little different sober... I started to burn myself (see my post in the self-harm thread) sounds stupid I know... and have lost about 25 pounds.

You can most definitely still overdose with these implants in you. And I strongly consider it at times. But I'm getting off track. I mention it because it's a major concern expressed by them. And something you should know.

Conclusion:
The Naltrexone itself is FDA approved. The ROA is NOT. It's not considered an 'experimental' procedure because the medicine itself is approved. The reported success rate by this place, in my area, (its fairly new with me being patient number 27 ish) is in the upper 90's. Nationwide it's in the 80's. But from what your post says about your feelings towards your sobriety I think you'll have a much different experience than myself. I was basically forced into this so I never really wanted to get sober like this. A break yes, total sobriety from H no.

Again, this is just my personal experience. Yours could be AMAZING. Just do your research and know what you're getting into.

Hope this helps some.

Good Luck!

 

[Crankinit]

^Thanks, it's good to get an account from someone who's actually done it, even under very different circumstances.

But found it way to easy to say, 'fuck it' and not take them when I gave into my desires.

Is why I want to go for the implant. No effort, no temptation. I'm basically looking for the opiate blocking effect of subs without the actual opiate effect it has itself.


I'm wondering - how much of the side effects you experienced do you think were the naltrexone itself as opposed to the PAWS from coming off heroin?

 

[Niko290]

I'm wondering - how much of the side effects you experienced do you think were the naltrexone itself as opposed to the PAWS from coming off heroin?

I'm sure PAWS is a factor, but that would only account for the mental symptoms really... and those are getting better. Some days are better than others and as time goes by the good are starting to outnumber the bad. Acceptance is key!! Finally coming to that conclusion has helped TONS!

But as far as the physical symptoms go it seems my case is either unrelated to the implant (according to the docs) or a very unusual case or an extreme coincidence from some other cause.

 

[Crankinit]

Interesting. I'll keep that in mind and proceed very carefully, since I'm very prone to side effects from medications and I've proven to be pretty sensitive to opioid agonists (I can't IV suboxone like most people seem to be able to, it always induces at least some degree of withdrawals, the first time I tried it I got hit with full blown precipitated w/d - not pretty).

 

[Niko290]

IDK Suboxone always kinda confused me.

If you have opiates in your system i.e. heroin, then the naltrexone in the subs would knock that off and attach to the receptors, but then the bupe, which has a stronger binding affinity than both dope and naltrexone, should knock off the naltrexone...

And if you don't have opiates in your system, the naltrexone would still be knocked off by the bupe....

Personally, I've never been put into precip. wd's when taking subs. I mainly took them when I was sick and it helped of course. The one time I took it without being sick was when I had basically no opiate tolerance and could still get messed up off subs. and I still didn't get put into wd's even though I already had morphine and probably oxymorphone in my system...

But I'm getting off topic.


The point is, with the implant, the place I got mine from makes sure you have no opiates in your system. So since there are no opiates in you then the naltrexone will simply bind to your receptors. And since youd be clean then there would be nothing for your body to go into wd's from. The naltrexone just acts like a wall then, preventing you from getting high, even if you were to do some dope. This is at normal dosages mind you. I believe it's like .1-.2mg/L of naltrexone levels is enough to block 500mg of heroin. So even if you were to try and push past the blockade.... you'd most likely od. For one because your tolerance is gone due to time and two naltrexone sensitizes the receptors, basically reversing your tolerance.

 

[Crankinit]

IDK Suboxone always kinda confused me.

If you have opiates in your system i.e. heroin, then the naltrexone in the subs would knock that off and attach to the receptors, but then the bupe, which has a stronger binding affinity than both dope and naltrexone, should knock off the naltrexone...

In theory - in practice I injected my suboxone dose and ended up on the toilet for an hour, spewing all over the floor and sweating through my clothing I've since tried it with lower doses (down to 1 - 2mg) and even then there's a definite withdrawal effect, although it's less severe.

The point is, with the implant, the place I got mine from makes sure you have no opiates in your system. So since there are no opiates in you then the naltrexone will simply bind to your receptors. And since youd be clean then there would be nothing for your body to go into wd's from. The naltrexone just acts like a wall then, preventing you from getting high, even if you were to do some dope.

That's exactly what I want. Sounds like I should progress carefully though. But I've still got 14mg to taper, so plenty of time to research and plan ahead.

 

[Niko290]

In theory - in practice I injected my suboxone dose and ended up on the toilet for an hour, spewing all over the floor and sweating through my clothing I've since tried it with lower doses (down to 1 - 2mg) and even then there's a definite withdrawal effect, although it's less severe.

It could also maybe been just too much opiate for you? I know subs are PRETTY strong in people with little to no tolerance.

But yes, good luck on your taper and your sobriety! I wish you the best.

 

[Crankinit]

It could also maybe been just too much opiate for you? I know subs are PRETTY strong in people with little to no tolerance.

Give me some credit, I know the difference between "too high" and "intense withdrawal" Putting aside the question of whether bupe could make someone "too high" when they have a 120mg IV oxy/morphine tolerance, getting sick from excessive dosing doesn't cause diarrhea, or intense sweating and a massive leap in heart rate, or painful aching in your muscles. And it would have lasted all day with bupe's half life, as opposed to just 90 - 120 minutes, and it wouldn't have occured to a lesser degree when I tried the much lower doses.

But yes, good luck on your taper and your sobriety! I wish you the best.

Thanks

 

[Captain.Heroin]

I think you missed my point. I'm not worried about the suboxone, I'm worried about the constantly available heroin/pharms once I don't have suboxone to make getting high more effort than it's worth. Given my history, it's not an unreasonable concern.

Then stay on suboxone.

My response might sound harsh, but it's honest.

you have to be in utter PAWS for a few weeks before you start naltrexone for it to be fully effective

for full-on addicts (I used to be one) I would have found something to shot up before the "ideal period" evolved

I knew 2 people on BL (none in real life) who were fully happy with naltrexone and its effects

this leads me to believe most of us ("addicts" to the level of long-term opiate use, possible needle use) cannot benefit properly from naltrexone

I also worry endogenous endorphins (the natural "feel good" chemical releases our body makes from eating, sex, etc.*) being suppressed by naltrexone's antagonistic nature.

Much and I'm wishing you the best in your recovery

*I'm sure you know about these chemicals Crankinit; I'm just explaining for all the other visitors and members who need it broken down

 

[Crankinit]

Then stay on suboxone.

My response might sound harsh, but it's honest.

It doesn't seem harsh to me (a little abrupt and uninformed maybe), your opinion is your opinion, any productive input is good

That said, stopping suboxone isn't something I'm doing on impulse, or because of some external pressure or some idealistic notion of what "sobriety" entails. I've got a whole pile of reasons for wanting to stop taking it, and I only came to the decision to do so after careful consideration.

Firstly because it ties me down to a city I've been wanting to leave for a long time and in general hinders my ability to travel (especially spontaneously) and my finances. I want to move on with my life, and I can't do that while I'm tied to my doctor and my local chemist.

Secondly because it's having a fair few major side effects. My testosterone plummeted 2 years ago after 18 months on subs, and I'm now stuck wearing itchy, uncomfortable, inconvenient and expensive patches to keep my testosterone levels high enough that I don't suffer debilitating fatigue. On top of that, I've started experiencing fairly severe constipation in the last 10 months, which only responds to a high dose of laxatives which makes me nauseous, turns my guts to cement and then has me running back and forwards to the toilet for 3 or 4 hours. Basically having to poop has become something which consumes an entire afternoon every week or so

I've made assorted lifestyle changes which have helped with these problems to a degree, but I'm still reliant on these medications to deal with the side effects. As you can imagine, I'm concerned about the long term consequences of these side effects, the side effects that could be caused by the medication I'm taking to deal with them, further side effects which could possibly pop up in the future the longer I stay on the drug, and finally the likelihood of other effects, less obvious or long term, that all of this could have on my body. There's the possibility that these side effects will abate as I lower the dose (although they haven't so far), and if they do I'll factor that into my decision.

Finally, there's the simple fact that I can't stay on suboxone forever. Eventually the day will come when I'm going to have to stop letting disgusting orange strips of plastic dissolve in my mouth every morning and allow my body to rebalance itself so that it isn't dependent on opioids. The longer I leave this process, the more difficult it's going to be.

Of course, going back onto suboxone is always an option if I come off it and bounce right back to getting high, and it's one I'm open to. But I feel strongly that after nearly 4 years and all the problems suboxone has caused, I would be doing myself a disservice if I didn't at least make a decent attempt at coming off it and going opioid free. I figured naltrexone could help with this as a temporary stopgap, so I created this thread for input and anecdotes.