Opioids Difficult situation - tapering off of opiates using Suboxone

[TheMoney]

Ok, first of all, I've been taking Suboxone for the past year and a half. I started with 12mgs everyday, but around August I started cutting down, most recently in April I was taking 4mgs every other day contrasted with 8mgs on the other days. Basically, 4mgs 4x/week, 8mgs 3x/week. Then, my Sub. doctor did something ridiculous and doubled my dose, so I was taking about 16mg/day for the past 2 months - she did this because I had back surgery coming up and I was in a lot of pain, and at the time a lot of problems were going on, and she wasn't cooperating and I just freaked out in her office so she randomly doubled my dosage (I have no idea, it was shocking to me).

Anyways, I had to have back surgery 2 weeks and 2 days ago - MAJOR back surgery.

^^Hopefully this will make it easier to see that I had back surgery 2 weeks ago. I know I write a lot and people don't want to read all that text, but the important thing is that I will still NEED to take the oxys later on FOR PAIN. Right now I'm just trying to BREAK MY PHYSICAL DEPENDENCE, so that I don't have to take them every few hours and can just use them for pain.



I stopped taking Suboxone 3 weeks and 2 days ago. I had 30 15mg oxycodone's to last me for a week, from Thursday to Wednesday the 8th(the morning I had surgery). Since my surgery I've been prescribed 30mg oxycodone's, and I've been taking those about 2-3x/day and at first my dad was also giving me 4mg Dilaudid's with some of those doses. My problem is that every morning I wake up in withdrawals because the oxy has worn off and I'm physically dependent on opiates. I can get up, take a 30mg oxy, and still have leg pains, and it's just annoying as fuck. I take a nap, wake up, and I'm miserable. So, what I want to do is break my PHYSICAL dependence to opiates using suboxone. I have 32mg left... I know trying to break my dependence using the oxy's is an exercise in futility because I don't have enough and I've never been able to do it before (taper using oxys).

I have tapered off of heavy opiate use in rehab before using suboxone, and as I mentioned above I WAS on the slow route to being tapered off, but I had to have this surgery, and my doctor acted inexplicably doubling my doses. In rehab the taper was something like this:
Day 1:4mg - morning, 4mg - night,
Day 2: 4mg - morning, 4mg - night,
Day 3: 4mg - morning, 2mg - night,
Day 4: 2mg - morning, 2mg - night,
Day 5: 2mg - morning, 2mg - night,
Day 6: 2mg - morning


Something like that, I don't remember exactly. I've also read about people using a taper method of taking 4mg every other day. What I'm asking for is advice on how to best taper off of opiates in a quick manner. I'm really committed to doing this because I'm tired of being uncomfortable all the time, I'd rather get the misery over with and be able to use my oxy's for pain as I need them instead of using them for maintenance as well.


I'm not sure what plan I'm going to use exactly, I took 4mg this morning, and I'm thinking I won't take anything today because of my limited resources. I feel fine now having taken the 4mg's this morning, and I have a good mindset going into this. I would like any advice, if you think that's a feasible plan considering my history of opiate use (year and a half on suboxone, past 3 weeks on oxy's though, and dilaudid the 3 days I was in the hospital and some when I was at home, so I would think my tolerance level is down some, but I'm not sure, that's why I'm asking).

Also, yes, my pain level is down enough from the surgery that I feel that I can go a week without taking the oxy's, but I also have them if I need to take them. I don't think I could do a 2 or 3 week taper, that's why I'm asking specifically about a short taper, within about a week or so and your thoughts on that.

Any help would be greatly appreciated!!


*EDIT* -- Sorry, I didn't see there was a tag for Buprenorphine specifically instead of just Opiates, but other Opiates are also involved in this situation.

 

[Wolfmans_BrothEr]

I'm not a pro on tapering, I've done it myself but it was really slipshod. A friend of mine did a bupe taper where he took 8mg the first 2 days, then 4mg, 2mg, 1mg, 1mg, .5mg and that was it

Theres a taper megathread you should check out or ask a mod to move it there for u

 

[brighton]

your last few days on the taper should be more like 0.25mg or 0.5mg.
bupe has a much higher nasal bioavailability (since you have limited resources)
good luck!

 

[TheMoney]

I have the strips, how would I snort them? And good call on going down to 1mg, .5mg, etc at the end.


I did just end up taking another 4mg for the night. It's been about 12 hours, and that WAS my original plan. I was thinking about the 4mg every two days, but I was starting to feel hot, uncomfortable and other symptoms... I figured I might as well start it off how I knew it worked and save myself some trouble. I don't want to end up feeling really shitty tomorrow and taking an OC or something, lol. I don't think I would, but, thinking about it, it just seemed like a more reliable way to do it (take 8mg the first day or two -- I'm aiming at not taking 8mg tmrw, but we'll see).

 

[Wolfmans_BrothEr]

^honestly dude flush your OC's. If you really wanna stay clean you may not feel as if you need them while on the sub, but once you kick the bupe you'll be lookin at those OC's in a whole nother light..

Best case senario is you'll taper down on the bupe and by the second day you'll pop the oxy and right there you've lowered the line of what your willing to do/not do and from there you'll say to yourself "fuck it I did it that one day, I can do it again without any problems" and your sobriety is seriously compromised from there

Just my .2

 

[suessmayr]

I agree that it is highly advisably to attempt a taper with subs rather than with oxys. Oxycodone is just too intensely pleasurable to even bother giving up, I mean it's almost illogical to try, and it leaves the body too quickly.

It's obviously crucial that you wait at least 24hrs before getting on subs to avoid precip wd's.

I would also start on the smallest dose that can work for you. Wait as long as you can after your last dose of oxy, then take something small like 2mg subs. If that's not enough, take another 1mg. Then reduce as slowly as your resources will allow.

In my opinion it is crucial to use what you have intelligently, otherwise you'll run out and justify getting back onto oxy to finish the taper, which will almost certainly fail.


S

 

[TheMoney]

^honestly dude flush your OC's. If you really wanna stay clean you may not feel as if you need them while on the sub, but once you kick the bupe you'll be lookin at those OC's in a whole nother light..

Best case senario is you'll taper down on the bupe and by the second day you'll pop the oxy and right there you've lowered the line of what your willing to do/not do and from there you'll say to yourself "fuck it I did it that one day, I can do it again without any problems" and your sobriety is seriously compromised from there

Just my .2

What are you talking about? Did you even read my first post? I just had a major back surgery that caused the most extreme pain I've ever felt in my life. Here's some pictures of my new spine and the scar:

I've been in recovery before, and that's why I've been taking suboxone for a year and a half. I don't go to meetings anymore (NA), but I wouldn't consider myself in 'active addiction' like I used to be. I don't take painkillers, do coke, or shit like that anymore - or at least not in a while and definitely not with any frequency. However, as you can see from the pictures, I just had my spine remodeled, and my back hurts. The surgeon and his medical partner were very anti-pain medicine, as are all my doctors, but even he admitted I would need pain medication for probably at least the next 2 months.


My problem is that I've been taking suboxone for a long time - a long acting opioid - and now I'm taking OC's - a short acting opiate. It's causing me to wake up with withdrawal symptoms and to feel shitty unless I keep up with my OC's, and basically forces me to take them as a maintenance pill like suboxone, instead of just taking them when I need to for pain. I'm tired of feeling like this, and I was 'scheduled' to stop suboxone by this summer anyways, BUT I had to have the surgery so things got messed up.

Now that my back is feeling better, I want to attempt to try to see if I can break my physical dependence, at least in large part, in a week or so. That way I can take the OC's for pain. And btw, I'm staying with my parents now, and they have my medication. They know I'm an addict and only give it to me when I need it. I've told them about my plan and they're even telling me I should probably wait and keep taking the OC's, but I want to move forward. I'm trying to make a lot of progress this summer, and breaking this dependence will be part of that success if I can do it right now (I know I will at some point this summer, I'd just rather do it sooner rather than later)


Anyways, thanks for your post, if I was in a situation where I was trying to stay 'clean' and didn't need pain meds, it would have been useful (and I always try to support people in recovery/the message of recovery, even if I don't actively claim to be in 'recovery' anymore).

and suessmayr, those were my thoughts exactly about trying to taper off of OC's. I tried so many times before when I was hooked on them and it never even came close to working. That's why I'm trying to break my physical dependence now, and only take them WHEN I NEED TO FOR PAIN (which my parents are helping with now). Thanks for your post. If I go back to taking the OC's the same way I was, that means the taper will have failed and I won't even bother trying again until I've run the gambit with them, and won't need anything anymore. Then I'll get my doctor to give me more subs and probably like a month long taper plan. But, I want to try to do it now IF I CAN. I feel like I'll be a lot more productive during the day if I don't have WD's waiting around the corner 24/7.

Hopefully all this makes my intentions/situation clear.

 

[suessmayr]

No I'm still a bit unclear as to what you are actually trying to do. You seem to mean to take subs and oxys simultaneously - you should NOT do this. If you take subs whilst on oxys, you'll precipitate withdrawal; if you take oxys whilst on subs, they will be almost completely ineffective. It's one of the other - are you clear on this? Subs is designed to render other opiates ineffective, usually even at massive doses.

S

 

[Wolfmans_BrothEr]

I read your first post although I kinda skimmed through it, I thought you were trying to get off the oxy by tapering subs and then eventually get off subs so you won't be dependent on anything

I mean if your taking subs to not be opiate dependent, you'll still be dependent on opiates. Suboxone is an opiate...

My bad I guess I read it wrong, but if your trying to get off the oxy don't you think you should get rid of them either way...?

I just reread your most recent post and you want to become independent but continue to take oxy once you've become independent? It seems to me like your just gonna end up in the same situation as you were left in..why would you taper down on subs only to start back up on oxy?? Why don't you just take less oxy each day to lower your dependence?

Am I missing something here? I could be since I'm drunk...

 

[ss2brandon]

14 day sub taper starting at 8mg decreasing by .5mg every day. day 15 ultra rapid oxy taper.

 

[TheMoney]

I know it seems ironic that I'm 'tapering off of opiates' only to continue taking them... it's not that you're drunk Wolfman, that sounds confusing, even to me, lol.

Alright, here:

1. I'm physically dependent on opiates because I've been taking suboxone for the past year and a half, and switched to oxy's the past 3 1/2 weeks because of my back surgery.

2. Because I'm taking oxycodone now, which is shorter acting than suboxone, I often times FEEL WD symptoms - like when I wake up in the morning, or if I take a nap, or even if I don't take a pill for 5-6 hours.

3. I don't want to experience these constant feelings of slight withdrawals. However, I don't have enough oxy's/I don't want to take that many oxy's to keep them at bay 24/7. And really, no matter how many oxys I take the night before, I wake up in withdrawals every morning.

4. Because I don't think tapering off using OC's would be successful - in part because of their shorter duration, but also in part because I would just be too inclined to take whatever amount of OC I was given - I am going to try to break my physical dependence using suboxone.

5. After this has been done, if I'm successful, I will still be taking OC's, but only intermittently, and only when I need to for pain. My parents have all the OC's, so I won't be able to abuse them freely, and I really actually don't want to do so. I don't think I'll be taking them often enough to build back up a physical dependence, certainly not one as strong as the suboxone has placed on me.


That's my situation. I will still be taking opiates for pain (which has gone down dramatically, and I think will continue to improve), the point is not to stop taking them completely, but to make it so that I DON'T HAVE TO TAKE THEM TO AVOID WITHDRAWALS.


So far, Day 1: 4mg - morning, 4mg - night


I'm interested in what brighton said about getting the maximum use out of my suboxone. How can I make my suboxone strips into something that can be insufflated? Will that be more useful? Etc. I only have 24mg left now.


Also, I won't be taking oxy's during this time while I'm taking suboxone and probably not for a few days after I end my suboxone regimen.



Thanks for all your posts so far. Sorry this is so confusing.

 

[suessmayr]

So you were on bupe, then you had surgery and are now on oxys, and you want to get off oxys and back onto bupe, and then begin taking oxys intermittently? I agree with what someone else said; namely this sounds overly elaborate and kind of circular. Also, you cannot take the two meds together; it is strictly one or the other.

If you want to get back on subs, why not go to a prescriber? If you're serious about this I'd try to keep things transparent and open, rather than covertly dosing yourself at home.

S

 

[TheMoney]

The doctor giving me the pain medication is also my suboxone doctor. And again, I feel like I need to stress this point: Yes, I'll be taking oxy's intermittently, WHEN I HAVE PAIN, which will be at such a reduced level by the end of 2 months from now, that I won't be taking any oxy's at all unless I seriously harm myself.

I've had 3 herniated discs for like 5 years, I'm used to dealing with pain without narcotics (if you don't include suboxone the past year and a half, which I wasn't given for pain, but for addiction problems -- it's also not a very good painkiller). My main weapon against pain are high powered anti-inflammatories that I can't take now while the screws fuse with my spine. I'll be able to start taking those again after a while and that will become my main painkiller again, as it was before the surgery.


All I'm really trying to do is to break the physical dependence now so I don't have to deal with 2 months of 24/7 light withdrawals that are gonna show up any time I don't take an oxy or don't take enough oxys. I want to be able to take the oxy's JUST for pain, which will not be every day unless something really bad happens.

I'm not trying to 'get off oxys and back onto bupe' -- I'm trying to break my physical dependence to all opiates/opioids so that I don't HAVE to take something everyday or else I have withdrawals.

 

[suessmayr]

Then it sounds like you need to either (1) just stop taking the oxys, maybe with the help of paracetamol/codeine OTC meds; or (2) get onto a low dose of bupe and then taper off that to zero.

I can't help but remark that, in order for this to work, you would have to be extremely sparing with the oxys once you come back to them. Once a person has been addicted and then got clean, it takes much less for them to get re-addicted. You would be running a great risk by using oxy's more than even once a week. Otherwise you'll just be back where you started.

S

 

[TheMoney]

What are some codeine OTC meds? I didn't know you could get codeine over the counter?

And, about becoming 're-addicted': I'm aware of the risk... trust me since I've started taking them again I've more than once thought about different doctors I could go to down the road, etc. However, for this time period my parents have my pain meds and give them to me only so often. They know I'm an addict, and are especially careful with oxys.


So far for Day 2: I slept well, probably the best night of sleep I've had since my surgery, I woke up tired/lacking energy.

I ended up taking 2mg suboxone at 2pm this afternoon


I'm also interested in what brighton said earlier in the thread about getting more out of my suboxone strips.. how could I do that? He said to snort them in a water solution? How does that work? I have 22mg left.

 

[suessmayr]

Most western countries (I live in Australia) sell OTC formulations like: 8mg-15mg codeine + 325mg-500mg paracetamol/acetaminophen/nurofen. You can also get these same with added things like anti-histamines (doxylamine succinate, diphenhydramine) to helf sleep.

Also you can often get cough-syrups which contain dihydrocodeine only, as it is a cough-suppressant. These are generally harder to get than the tablets. Both the syrups and the tablets are either 1) kept behind the counters or 2) available only after satisfying the pharmacist that you need them and are not an addict.

I'm not encouraging you to get these; I myself never really bothered as I think it's too much work for too little payoff, and runs too great a risk of getting liver poisoning from the acetominophen and other shit.

S

 

[TheMoney]

Yeah I don't know about those, I don't think you can get anything that has codeine in it OTC here in the states...

I was feeling decent all day with just the 2mg I took this morning, but my back was starting to really get irritated by tonight and, as an addict, my curiosity was peaked with this 'different' way of taking suboxone, lol. So, I tried it with 2mg... dropped it into the spoon, swirled it up into warm water and dropped it into my nose... even though i was breathing VERY lightly and pushing VERY slowly, it still felt like a lot went into my throat, but I do feel a big difference between this morning and what I took now. I think part of it might be bc the only syringe I can get are the 3cc ones that are kind of thick, they only put out big drops at once no matter how softly you push it.


I've satisfied my curiosity, IDK if I'm gonna bother doing it again until I'm down to the end and hopefully taking 1mg/.5mg in a few days. I'm gonna really try focusing tomorrow to just take 2mg, but I'll have to see. I took less than I 'scheduled' today, so if I feel like shit in the morning, I'll go ahead and take the 4mg, but that'll be it for the day.


Day 2: 2mg - Morning, 2mg insufflated - Night. Felt good all day. My back hurt, but the pain was tolerable, especially considering all the walking I did yesterday. I didn't exercise any today, but I probably will tomorrow. So far so good. No cravings (besides to see how suboxone was insufflated, lol, but I could have had my dad give me oxys at any time. He even offered, but I didn't want to get off track).


I think I'm gonna keep this thread updated with how I do through this whole thing if that's alright with the moderators. I appreciate everyone's posts.

And sueesmayr, I have plenty of benzo's and muscle relaxers to help me sleep and get through the times when I am gonna feel real shitty. Benadryl would be the last thing I took, lol.

 

[suessmayr]

I'm pretty sure you can get some sort of codeine OTC in the states. Despite the primitive nature of your health system I would be surprised if it was prescription only.

I think it's important to realise that if sometimes you dose sublingually and other times you dose intranasally, the doses you're giving your body are not the same. Like 2mg intranasally it closer to 1mg whereas 2mg sublingually is closer to 700ug. In the long term it's self-defeating and unless you're short on bupe and therefore are going to dose intranasally always it will probably just arrest your progress.

Good luck man,

S

 

[TheMoney]

I didn't take any suboxone today, didn't have any BAD feelings of withdrawal, although I wasn't feeling my best.

I was wired all last night after the 2mg insufflated.


Anyways, I was thinking today might be my last day of suboxone, depending on how I feel tomorrow... but tonight my back is really killing me, so I asked my dad for an oxy. I don't see this as slowing me down any at all, it'll be gone in the morning. I feel much better about taking an oxy than I do a suboxone as far as my tapering goes. I think I'll be the in clear soon, and it feels easier than I suspect.

I agree with what you're saying about changing methods of administration, and I really was just curious to see what that did/if it was different (it was), but I won't be doing that anymore unless I get down to .5mg and really need to stretch it out... which I won't need to do IMO. In part, because my dad got 6 more 8mg suboxone pills today from one of his friends, he gave them to me, but I still didn't take any bc I really wanted to go today without taking any/stick to my original supply if possible. Like I said, back surgery, shit hurts tonight, I needed pain medicine, but I feel good about how things are going so far.


Remember, this isn't to be 'clean' from drugs, this is just to break my every day physical NEED for opiates; I'm still going to be taken oxys for pain.

 

[suessmayr]

If you're trying to merely cut down on your use and not terminate it altogether you probably just need to use less and less; as little as you can. It'll be like mild but not total withdrawal. If you have no mind to stop altogether there is probably no real need to abstain, just cut down, use every second day etc.

S