need advice on trying to be sober

[njaguilar10]

I have recently slowed my suboxone down to .125 mg from 05/06. Last night was the first night I skipped a dose... I'm finding it very hard to not have anxiety from not taking my once daily dose at bedtime of .125 suboxone and even clonazepam doesn't work to help.
I'm wondering if I should just take one tonight, skip two days then take another skip three days, then another then skip 4 then done or should I taper my way down even lower to .06 or should I just jump and deal with the withdrawal process. Will it be not too bad? From tapering I haven't had much symptoms. Alot are rls and insomnia. I did have a oxycodone habit of 120 mg daily and the withdrawals were so bad I couldn't sit still, my pelvis felt as if it was grinding on my hips... but thankfully haven't had anything even close to that. It's been about 23 days since I have been on an incredibly low dose but ik suboxone is very potent even at low dosages.

 

[JohnnyPotSmoker]

I don't understand fully the concept of skipping days, but if it works for you, then more power to you. I have typically heard of the taper method being a daily/weekly reduction.

This will adjust your body slowly to the change so it wont be perceived as much of a struggle and you will likely have a greater success at coping and quitting in general.

For your sleep, if you are seeing a doctor, ask for something to help you sleep like seroquel or look into something over the counter like zquil. Just keep in mind, both can be habit forming and dependencies will develop when using any medication for falling/staying asleep.

For the anxiety, I would start a daily taper and small, changes to help the body cope with the withdraw. Make sure you are getting your suboxone from a doctor so you have the amount needed to properly taper.

If you find it extremely difficult, you can always go into a clinic, but a typical suboxone taper should only take about a week when done properly. Continued maintenance if required and a slow taper from there. The slower the taper, the less effects as your body will adjust to the new levels of opiates.

For stronger addictions, you can taper on a 1x per week reduction with little to no effects beyond the first day or so. A lot is mind of matter, but hang in there.

 

[simco]

OP, could you tell us: a) what was your highest suboxone dose, and b) how long have you been on subs? That will help people tailor their advice better.

As to your question, I agree with Johnny that skipping days isn't a typical part of a suboxone taper...I think you're likely taking on a lot of unneeded anxiety by doing that (basically entering WD repeatedly). In general, a *very* gradual taper (small steps down with long periods of adjustment between them) is best with long-acting meds like suboxone.

 

[Jabberwocky]

Welcome to BL njaguilar10!

You're on a super low dose. If you want to continue your taper, if that is working for you, do it. But IMO this is as good a time as any to collect some comfort meds and come off the buprenorphine. Get gabapentin to deal with the anxiety and RLS, it works pretty amazingly well. And as have been mentioned a non-habit forming sleep aid like trazodone or seroquel. You can use loperamide to help with GI issues like diarrhea or cramping, and clonidine to deal with the hot-cold flashes and blood pressure issues (especially at night).

Once you get get yourself set up for making the transition off comfortable, I'd say you're at an ideal place to make the jump. A couple questions for you, to help us give you the best feedback:

How long have you been taking buprnorphine prior to this?
What does were you taking before you started taper?
How long have you been tapering?

For your sleep, if you are seeing a doctor, ask for something to help you sleep like seroquel or look into something over the counter like zquil. Just keep in mind, both can be habit forming and dependencies will develop when using any medication for falling/staying asleep.

Medications like trazodone and Seroquel may be "habit forming" in some psychological sense, but these medications are used to help with insomnia among those detoxing and in early recovery precisely because they don't carry the same kind of risks of dependency as gabaergic sleeping aids. Also, antihistamines (like diphenhydramine and doxylamine) can make RLS worse, so many people avoid then during withdrawal.

If you find it extremely difficult, you can always go into a clinic, but a typical suboxone taper should only take about a week when done properly. Continued maintenance if required and a slow taper from there. The slower the taper, the less effects as your body will adjust to the new levels of opiates.

For stronger addictions, you can taper on a 1x per week reduction with little to no effects beyond the first day or so. A lot is mind of matter, but hang in there.

I'd say for some individuals, particularly those on a lower dose or those having only been using buprenorphine for a short period of time, a week of tapering may be enough. But for anyone taking a more common dose of 4-12mg who has been taking it for the recommended 6 months to two years, comfortably tapering will necessitate a process that takes far, far longer than a week.

 

[njaguilar10]

I am sorry I lost my password and noone was posting so I gave up for advice on here. I was tapering from 5/06 went 24 hours without any sub, took little pieces of full agonists for about a week went back to sub at .50, then to .25, then went off again for about 6 days with oxy 5mg for those days nothing large bc that was my doc. Then went back on sub @ .125 mg for about three days then just jumped... I was on sub since about Dec.
The highest does I have taken wad about 4mg a few times maybe like 2-3 times in a Month back in April and knew I was abusing it. I am on technically day 5 w/d almost six. I took my last 6/7 of .125 @ 5pm I had changed the time due to anticipation of feeling I needed it at bedtime to sleep. The 2nd day 48 hours I had some rls so I did the dumb thing and took a 5 mg perc. Last night was a little bad with rls but dealt with it got a shower fell asleep. I have been taking clonazepam for sleep at .5 mg but it's not working very well... the only thing that's been bothering me now is sleep and thinking about taking something to make it go away, I didn't really have any aches or pains other then tapering down I did. I have about 3 mg of cut up subs and a whole 8mg strip well I actually had 2 but I gave one away so I think I can do this. I want to appreciate and remember life not live in the fog. I am fighting hard

I have also picked up 1 day vitamins/minerals and magnesium to take daily. I have been drinking lots of water also. Times going quicker it's not such a pain. I think maybe some potassium or bananas would help. I would really like gabapentin but I've heard your body can get attached to them also. I have taken them for rls and sleep and it does work. I've had rls since a child but it's so annoying especially if you're tired it makes things miserable..

Also, b4 I took sub I had been abusing oxys for about 8 months at the highest maybe 100 mg more or less depending. I was drinking too. I was just lost... I had controlled abuse for the past 2 years but I never actually needed them and it never causes symptoms that I had noticed so I thought it was fine and there wasn't a repercussion... but I think the subs mentally helped bc I don't remember exactly the euphoria they gave me anymore since when I took the oxys in between subs it was just for bed so I didn't feel the high I went to sleep and woke up sober. I haven't touched a perc since two- three days ago...

 

[simco]

How are you feeling in terms of your overall sobriety (i.e. in terms of the title of this thread)? Are you having trouble staying motivated? Or are things going pretty well?

 

[njaguilar10]

I feel good about it, but just striving for full success as I feel I am not past the whole withdrawal. I am having some trouble staying motivated as I have noone that's trying to motivate me... I have an enabler around that's iggnorent towards the situation as I am easier to deal with his asshole ways when I'm all fogged up... things are going well and I plan to push through it, oxy withdrawal is hell compared to this, this is a cake walk and is all in time and mental discipline which I'm being very hard on myself this time I am done.

 

[njaguilar10]

Gawdddd I wish someone would post lol
Rls kicked in or whatever you'd call it..
My ankles and calves feel very sore; idk if it was from exercising too hard or what... I thought exercise would be good. I even had a ropinirole which I've never tried before and Alls it did was make me want to throw up and pass out smh.... I also wanted to add I am female 25, 120 lbs 5'4".. I think I have a high metabolism but I could be wrong...

 

[Jabberwocky]

If you feel like you could use some pharmacological stability for a bit longer, I'd suggest you try kratom. If I were you, I'd get some gabapentin though. There is far less risk of dependency with gabapentin than clonazepam. Taking it for a month or something as you transition to an opioid free lifestyle actually has far more pro's associated with it than con's.

Definitely prepare to spend good lengths of time taking hot baths or showers. Or going to a sauna. And get some Tiger Balm to rub on the muscles affected by RLS, under the joints, etc. This stuff can even make more of a difference than medication.

Also, you mentioned bananas and potassium. This is a really useful time to work on improving your diet. A lot of people either eat far less or only eat comfort type foods during the unpleasantness of withdrawal. However, eating a healthier variety of things like different things, particularly vegetables and fruits, can significantly improve (give great stability to) one's mood while going through withdrawal (and post withdrawal).

But definitely take some gabapentin if you have it on hand.

 

[njaguilar10]

See I don't have any gabapentin when I had taken it, it wasn't prescribed. I tried ropinirole but that was hell! Yes the clonazepam is bad ik I haven't taken it for a day and had tried to space the days out so it wouldn't build up..
I'll try to get gabapentin but idk what to say to get it... I don't have a doctor yet but I can go to the express. I feel good today but it's always the night. Kratom idk where to buy that but online? Do stores carry it? I also tried capascian rub and I regret that it burned my skin and I couldn't get it off... is tiger balm anything like that? I didn't have any aches or pains during these 6 days except those and no diarrhea but some stomach cramps....

 

[Jabberwocky]

Sounds like you're doing pretty well then. Tiger Balm is mostly menthol, it's kind of like Vick Vapor rub stuff, but better. Kratom yes, online, although it's illegal in some place (like the UK, if that's an issue for you).

How many days has it been again, six now? Then you're pretty much out of the woods withdrawal wise. Time to start doing fun stuff you enjoy to get those endogenous endorphins working again!

 

[njaguilar10]

No I live in US, I had looked it up in a struggle but I didn't know which one to pick and I saw you have to orally take it like in tea or powder... I'll have to wait for it anyways lol so wth right? I was just afraid that I could get in trouble for getting it; I am paranoid person lol. Yes @ 5pm today my 6 days ended and day 7 started I am so happy buy afraid at the same time... I hate when people say addiction isn't a disease with opiates it is a disease.... my heart goes out to everyone withdrawaling or even abusing. Ive been listening to music alot which i stopped only while on suboxone and it gives me that high. I have been exercising but I didn't today bc I think that's why my ankles and calves ached.. I took potassium supplements but I've got diarrhea for some reason and I haven't had it the whole time... so idk if it was that or a caffeine pill... suboxone makes you so tired

 

[Jabberwocky]

Take some loperamide for diarrhea if increasing your fiber isn't enough to deal with it. Nothing sucks like a good case of the runs.

 

[njaguilar10]

Is it going to hurt me with my withdrawal or set me back by taking 2.5 mg of oxy at night for sleep? & what if I try to space it out like every other day or should I just try to get gabapentin? This rls and insomnia is what bothers me...

 

[Jabberwocky]

If you want to avoid any more issues with opioids the gabapentin (or pregabalin or baclofen or maybe even robaxin) is advisable.

If you feel you can realistically use oxycodone at small doses responsibly go for it, but the only reliable way to avoid becoming dependent to the point of withdrawal is not using any more often than one day on four days off. So that doesn't sounds like it will help you much, hence why I suggest a non-opioid alternative like gabapentin.

You can take something like that daily for a month without having to worry about withdrawal when you come off it.

 

[njaguilar10]

Okay, that's what I had thought... I am not too worried about the gabapentin bc I have taken benzos for like a month straight and never felt any different after quiting but maybe it was due to taking opiates idk..
Thanks so much for your advise & congrats for your clean time!

 

[njaguilar10]

I tried to get gabapentin from the med express and they looked as if I was crazy when I said I came in for rls... they were very rude about stating oh this should be your pcp which I don't have one so that's why I had went there. They gave me nothing which downed my day to be worse as I am trying to do the right things I have started day 8, I am almost 7 hours into it and today has been so depressing... I guess that's the w/d idk..
Atleast, they booked me an appointment on 6/22 ( 8 more days, mid as well just do w/o unless it stays with me regardless) with their doctors so I can get checked for rls or atleast be seen for it and something be done... I have had it since a child I remember holding my muscles tight so I could sleep. I believe my son has inherited it also... some nights he says mommy my leg hurts, it's burning..
Ik I probably sound like a baby I am sorry.

 

[njaguilar10]

Okay, so I've stumbled onto a good question... if people say 4 mg is basically like the ceiling effect of suboxone which is basically like 8mg or whatever is higher since you really can't get "high" off of it. What is the difference when you taper from below 4mg if that's considered a ceiling effect? It just seems to me that no matter how low you dose it's really all the same when it's up 4 mg which doesn't really create a ceiling effect? It just seems to me that the withdrawal will all be the same under 4 mg... I am just thinking outside the box.. idk ps ik it has naxolone in which it blocks the high from suboxone itself and from other opiates and when you take less it's not alot and it leaves your body pretty quickly so how come when you take less you don't feel the effect compared to if you do take 4 mg??? Ik it all depends on someone's tolerance which I had no problem tapering down without bad w/d that I had noticed... it seemed all the same bc in reality suboxone didn't really get me high at the doses I took until I took about 4 mg but it's very hard to swallow at that point especially if you don't need it...

 

[Jabberwocky]

At lower doses, so around 4-1mg per day, buprenorphine agonist properties are slightly more pronounced. So it behaves a bit more like full agonist cousins in terms of subjective effects, although it is still markedly different.

In medical parlance, the ceiling effect refers to the point at which increasing the dosage of medication no longer correlates with any substantial increase in effect. I believe the technical ceiling dose of buprenorphine is like 24mg, however for a great number of people it seems to be lower practically speaking.

For all practical purposes, the naloxone in Subocone does nothing. It doesn't prevent the intranasal or IV administration of the medication like it supposedly does. It doesn't block the effects of other opioids either, that is all thanks to buprenorphine's extraordinarily high binding affinity to opioid receptors (few opioids have a higher affinity, although fentanyl is among them). So basically you don't have to take naloxone into consideration.

I jumped off buprenorphine at around 4mg per day after dropping down from the 8-12mg I had been on for the majority of 1.5yrs and it wasn't bad. I only really used temazepam and gabapentin to deal with it. But of course that was just the detox. I hadn't really addressed any other aspects of my development when I was on buprenorphine, so shortly after getting off it I was craving opioids pretty hard core.

I feel like most people would benefit from tapering down to a lower dose than where I jumped off though. I certainly see little benefit, if any, to jumping off at 4mg as opposed to 2-1mg.

And please try not to sell yourself short with what you're doing. Things won't always go as planned, but that doesn't take away from the hard work you're doing as you figure all this crazy substance use disorder stuff out for yourself. Particularly with detoxing very little about this is pleasant, so it would be more of issue if you weren't frustrated with some of your experience.

Do follow up with the referral to see the doctor you got from the walk in clinic you went to, or find your own doctor and make an appointment. It can be a really significant asset to work with a compassionate and professionally supportive clinician who is able to prescribe medication that can really increase the quality of your life as you go through this (more uncomfortable detoxes are actually associated with higher risk of relapse early on), which will help set you up for success in early recovery.