Alright
@Binky7766 you gotta listen to me right now. If you're looking for help in this situation, I don't want to be pretentious, but that person is me.
Getting on Buprenorphine, good for you! Tapering down? Holy shit, be proud of yourself. You are doing the right thing and you deserve to stand up and take a fucking bow, even if you're alone, you know why? Because we are often extremely alone in these times. Our victories are often our own. We do not live in a society that believes you deserve credit for getting off Opioids, we live in one when they say you should be ashamed for ever letting it happen and that you're damn lucky to have help.
You need to find strength in yourself. In people like me who have genuine love for my peers. You will often not get it even from the people closest to you. Be strong. You will reap the rewards.
Now, Buprenorphine (Suboxone/Naloxone 4:1) is an extremely complicated drug. There are some key elements that are important to understand. I will try to give you the bullet points, but you will have questions, ask them.
The Mu Opioid Receptor (MOR) is the "good one". It's the reason people love Opioids, why they become addicted etc. There are other Opioid receptors, but they are of much less significance.
Buprenorphine is most effective at doses lower than 2mg maximum per day. When used for pain (it is used for pain) doses are 0.3mg-0.5mg etc. Meanwhile, there are maintenance patients routinely on 24mg-32mg per day. It is known essentially, that the drug delivers diminishing returns bordering on uselessness when the dose exceeds this 2mg limit.
Addicts will continue to chase the high. They do not know any better. However, there is little reason for any person anywhere to even be taking more than 4mg Buprenorphine. If they need more analgesia, then then need a different Opioid.
As the dosage is raised, these diminishing returns at the MOR are overtaken by the effects of the peripheral receptors. Most people simply describe feeling numb. That is how I would describe it. There is nothing good that has ever come from me taking more than 8mg Buprenorphine.
You have made so much progress, which is why I have no doubt you can finish the job. You must know that as you go below 2mg Buprenorphine the experience of tapering will be different. It's not necessarily better or worse, but these changes can trigger a shaking of the foundation that you have built.
You might start noticing that your Buprenorphine dose is actually making you feel "good". This seems like nothing, but remember that everything creates a ripple and the extent of these ripples over time are often hard to see.
You may be reminded of why you like Opioids so much. You might make a tiny bad decision. This might lead to more bad decisions. This is why you need to be prepared. Know that below 2mg Buprenorphine, the taper will become a little bit more difficult. You will likely begin to feel different. Sure, you're on Opioids on paper, but you're not actually "on Opioids" right now. You're just numbed from them. You may come into contact with feelings that you haven't felt in a while. You need to be able to talk to someone, share your feelings and be honest about how you feel. Being honest, even about seemingly pointless shit, it's important. Telling people you have cravings... so embarrassing.
Well, that little bit of embarrassment could get you the love you need to get you through. For someone who loves you, there is no embarrassment.
SURGERIES
This is going to take some serious planning. You absolutely need someone you can trust implicitly to help you with medications. I don't care how sober you are, you have to give someone else those Opioids and have an understanding of how and when they will be administered.
You will need to have someone who you can talk to, who will listen to you and who loves you. I'd love to tell you that you're capable of doing it yourself; maybe you are, but we're not playing a 10$ game of blackjack, this is your entire life.
So, once you have someone on your team who can help you control things, we can think about Opioid alternatives. There are many drugs that can help you reduce your Opioid intake. Some of them are addictive in their own right, however, if only used as needed, you shouldn't have to worry about any consequences.
We are not discussing ethics or morality, I'm just telling you straight up what I think.
Gabapentinoids - Gabapentin (Neurontin); Pregabalin (Lyrica); Phenibut (Last resort, we will talk when and if the time comes)
Pregabalin in the context of multimodal pain management may be associated with reduced opioid consumption and other medical complications in patients undergoing TKA, including previous users of chronic pain medications.
pubmed.ncbi.nlm.nih.gov
See above article. If you need me to break it down, let me know. Essentially, Gabapentinoids are known to reduce the need for Opioids post-surgery. The study suggests a 30% decrease in the need for Opioids (at least, I've read closer to 50%).
If you do not have a tolerance, this will mean 1,200mg-2,400mg Gabapentin/300mg-600mg Pregabalin. These drugs work in concert with your Opioids and do not contribute to your Opioid tolerance in any way. You would need to take Gabapentinoids daily for a few months prior to having to deal with anything serious. If we are just recover from surgery, than there's nothing to worry about.
Muscle Relaxants
Cyclobenzaprine (Flexeril) is a non-Opioid, non-intoxicating drug that can help reduce pain. For the record, it's only useful if you're using it with many other things in which it may be a "cherry on top". I've met very few people who have raved about their experience with this drug.
Carisoprodol (Soma) is a "Non-Barbiturate" drug prescribed to help treat pain. A "non-barbiturate", confusingly, is a drug that acts essentially like a Barbiturate in every way despite being chemically distinct. It was prescribed as a muscle relaxant for some time. I believe it relaxed muscles because it relaxed the central nervous system. This is an extremely effective drug when used in combination with Opioids. You can drastically reduce your Opioid consumption with this. Do not take this before talking to me about it. It is potentially quite dangerous. If used irresponsibly, it can easily kill when used with Opioids.
Benzodiazepines
These drugs have no use beyond the fact that the separate you from the pain through numbing your mind. However, the "synergy" of Benzodiazepines and Opioids leads to a much lower required dosage of Opioids. This is also quite dangerous if done irresponsibly. If done right, we will get you through this.
Cannabis
I shouldn't need to explain this. It's medicine for the body, mind and soul. A great analgesic, appetite-stimulant, hypnotic and anxiolytic. Use it!
When you go in for these surgeries, you absolutely have to have a rock solid plan. If you want my help, you have it. However, you will need someone else in your life who you can trust to help you through this.
You got this man. I'm so proud of you. If nobody else has told you that today, I'm proud. You have your whole life ahead of you because of the hard work that you have already done. You just keep doing your shit dude. I've got your back as do we all.
I have been back on Subutex for a few years now. I was about to get knee surgery last year. I told the surgeon prior that I was on Subutex, he said it was fine and that he did surgeries all the time on people on it. He asked if I wanted Oxycodone and I said no at first but I called later to have him send it in. Ironically it fell through because the anesthesiologist wanted me completely off my 2mg dose in 2 weeks.
