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Bupe New on Bupe after heavy Oxy - Need Advice ASAP

love88 said:
So I started again tonight... I don't know what happened this time... I got home from work at 7pm tonight(at that point it was 24hr since last dose of half bundle of D) and i was takeing Gaba all day bc i knew i wasnt having and opiates and strting sub. So when i got home i fell right asleep. Then i woke up at 12am ( about 30 hrs now)with horrible WD so i took 2mg of sub i waited loke an hour n half and i was still in pain; very bad RLS so I redosed another 2 mgs of sub. Now another hour has gone by and my legs still hurt a bit.... Not going to dose again.... I don't want to go above 4mgs. Also took some more GABA and muscle relaxers. Hoping sleep will come soon very disappointed that jus 2mg wouldnt work. I don't know why it worked last week?!
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Did you take GABA last time before you started the subs? Did you wait as long (30hrs)? I would guess both of those could be variables that impacted the efficacy of the subs. Or perhaps it is because of how some claim withdrawals get progressively worse, or your body is just in a different state and not able to fix itself as fast for whatever reason.
 
I have an urgent question, if anyone has any advice. After a 21 day taper using Suboxone, I am now down to 0.5 mg per day but am cycling in and out of withdrawal. I posted the details of my previous MS Contin use on the Buprenorphine Withdrawals thread (and have tried to search everything I could). In brief, was taking 105 mg MS Contin twice a day orally, often chewed. I tried to follow Tommyboy's suggestion to go to zero on the Suboxone after 10 days, but the withdrawals were way more than I could handle with work/family, etc.

So now I have a week or two to really ride it out, and I'm wondering if I am better off switching briefly back to the MS Contin to blow the Bup off the receptors and hopefully reset the withdrawal schedule to three hard days and whatever residual symptoms after that. Or will it be easier to do the 7-10 days that the only knowledgeable doctor I spoke to said would be the "physical symptoms" of coming off the Bup. It was his view that they started me on much too high a dose for a rapid taper -- due to the precipitated withdrawals at the front end -- and then the nerves reset to the Bup dependency after day 10 or 11. I have tried upping the Suboxone dose, but short of going up further than I can stomach, it doesn't help. So I plan go to zero no matter what, I just want to know if anyone has any experience with this, cause the doctors sure don't.

Let it be a cautionary note to anyone considering Suboxone. There probably is no middle ground. You either have to do a rapid taper, starting from as LOW a dose as possible tapering down over ~4-8 days detox (as suggested in this thread), or you have to have the time and patience to do a longer maintenance plan and come off over months (and eat the longer withdrawals from Bup at the end). If this is crap, please correct it. I seem to be getting the pleasure of going through withdrawal sequences twice over a month for two different opiates.
 
^^ Can you give us an idea of what kind of taper you have done over the past 21 days? Also, what symptoms are you experiencing both while using suboxone as well as after waiting quite awhile after your last dose?
 
Well, perhaps you have already received your answer, or have just made up your mind regardless. However, for discussions sake, especially since your scenario is so very similar to what I experienced / am planning, I will explain why I asked what I did.

Overall, I think it may be a little optimistic to think that you can go from 21 days of a long acting opiod like suboxone and completely reset the DT profile with only by only "briefly" switching back to MS Contin. I am not quite sure what you mean by brief, but for arguments sake lets say you mean 3-5 days. The issue I see is that many people do not even feel the full effect of the bupe detox until between day 3 and 6. Therefore, if you started at a high dose, and have only recently started to do a very rapid taper down to .5mg, then you might have a lot more of the bupe built up in your system than you think. Especially since you said you tried uppping the bupe to as much as you can handle (presumably towards the end?). Consequently, my fear is that you will reactivate some receptors with the MS Contin, while others are still be activated or have memory of the bupe, resulting in a hybrid DT profile. I am choosing to go a similar rout; however, I am choosing to stay on the full agonist for a longer time frame (3-4 weeks) to try and ensure that I bypass the all bupe related DT. However, I this is a hypothesis and I could be looking at this wrong, so I would be very interested to hear your decision and results given the striking similarities of your experience / plan.
 
Thanks so much for responding, VisceralChems. It actually helps just knowing there are others out there facing this.

Firstly, your fear about the two-tiered withdrawal was mine as well, so I went to zero today to try to ride out the Bup withdrawal. I don't have enough meds left, at least in terms of one substance to do a 3-4 week plan or even a two week plan.

The Suboxone taper (which I adamantly DON’T recommend for anyone) was in daily doses mg: 24, 16, 18, 12, 9, 6, 4.5, 3, 2, 1.5, 1.0, 0.75, 0.66, (hit first wall), 1.0, 0.5, 0.375, 0.25 (hit 2nd wall), 0.4, 0.5, 0.5, 0.5, 0.5, zero.

The reason the dosing was so high at the beginning was a mistaken attempt to overcome the precipitated withdrawals. So a bad trip all round. In terms of the symptoms in cycling in and out of Bup withdrawal, it was pretty much everything WD brings but in less severe and less combined form (e.g., all GI stuff, non-event anxiety, pain in back/legs, exhaustion, insomnia, stomach cramping, nausea, hyper-sensitivity, etc.).

So on day one of going to zero on the Suboxone, it is definitely the pain and exhaustion that are dominant with some anxiety and the GI stuff. It is not as bad as full-on withdrawal, as I have done it mistakenly twice. But it is pretty awful nonetheless. The fact that the end is less clear for Suboxone makes it mentally more challenging to stick it out. I have legitimate pain issues that get hyper-flared when the nerves go berserk. That will be the hardest thing to for me to get past and hold.

One thing in your second post. As near as I can tell, the high dose Bup was out of my system for practical purposes after 14 days or so. It was enough time to reset the receptors to Bup dependency, but also enough to get the body to be dominated by recent doses. I know everyone is different, but all my research would suggest if you do go the alternative route with a full agonist, it won’t take 3-4 weeks to reset. But please do not take my word for it, as Bup is nasty and I am definitely a non-expert.
 
I can definitely relate! My experience was VERY similar, and I feel for you because I know what it is like to be in such a horrible state for so such a protracted timeframe and without any comfort of knowing when it will finally stop due to so many unknown factors.

My initial concern about you having residual large doses of bupe in your system was based some comments you previously made about upping the bupe dose, but it doesn't sound like that is actually an issue as you have been at a relatively low level for quite some time.

I have seen several people propose this (switching from the partial agonist to a full agonsit temporary to shorten the WD symptoms), but I never saw where anyone actually did it and posted a follow-up regarding their experience. So I really hope it works out for you, and please keep us posted!

Lastly, I am going 3 - 4 weeks just to be safe, but also to allow myself time to further taper and hopefully reduce the intensity of the acute phase.

Have you spoke with your doctor about potentially obtaining some other medication to help with the nerve pain during the DT phase (such as Gabapentin or Lyrica)?

P.S. My doctor didn't like my approach, no surprise, and actually wanted me to take a naltrexone shot! This would have been pretty devastating to me mentally given my current state, as it would have probably surely caused me another 2 - 3 weeks of hell, and I would have freaked out for sure.
 
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Hey Visceral, just in case I was confusing on this point, I didn't in the end go with the switch back to a full agonist. I just came off the Suboxone. It is pretty bad, but it is mostly pain that I am not managing. I have also not seen any accounts of anyone switching back from Bup to an opiate/agonist just to taper down to ride out the 'normal' WD period. My one thought is that 3-4 weeks is a pretty fast taper for that plan too. I don't mean the residual Bup, which I can only speculate on based on what I have read (incidentally, there is a good approximated formula for half-life breakdown of Bup somewhere if you google it. It varies by person, and most docs say there's no meaningful residual after 5 days, but that's crap).

I do have Gabapentin in abundance, but that only helps with the WD nerve pain/hyper-sensitivity, not with the core pain. If it did, I probably never would have been put on a round the clock dose of MS Contin. What does seem to help -- and this is by no means a recommendation to anyone -- is sedating myself sufficiently to ride out the worst of the night WDs and pain. It has the effect of letting the muscles relax, which stops all the secondary spasms from the core pain. Good luck with your plan. I hope you have done the 3+ days of full-on opiate WD, because it is no picnic either. Knowing the timeline helps, but everyone is different.
 
^^

3 - 4 weeks may be a little fast, I will just have to see how it goes. What taper plans have you been seeing that make you think it is too fast? Also, keep in mind, after my break, I am only at a fraction of what daily doses I was taking (<=1/4), so it is not like I will be tapering down from the original 440mg/day habit.

Yes, that is what I was referring to, the Gabapentin for the nerve pain since you previously mentioned your nerves going berserk.

Well, at least you will not be taking a step backwards by going back to a full agonist. I am rooting for you!
 
Visceral: For a long-acting opiate, I tapered over about six months. I once tried a 3-week taper, and the end was hell. If you are switching back to low dose, maybe that makes a big difference. I am sorry there isn't any information on this route.

Day 2 of zero Suboxone is not great, but it is certainly not full-on WDs. If it weren't for the core pain, I would be fine to ride it out. Many warnings from people that the full withdrawal doesn't start until day 3-5, but I am hoping since I was already cycling in and out that that's not the case. God I hope.

I preface this by saying I am absolutely the wrong person to be giving advice on this subject. But if you are really able to switch over to a full agonist for 3-4 weeks of taper, have you considered then doing a rapid detox with Bup at the very end (if you still have some). There's gobs of information on BL about rapid taper from an opiate using Subs/Bup with minimum withdrawal of either substance. My only fear is that you would reactivate the receptors to your previous Bup levels. That would be totally disastrous. Also, read absolutely everything that people write about precipitated withdrawals and then remember you are on a long-acting opiate. It stays in your system longer and you have to take that into account before going to the first Bup. I realize this may not be a good path, but I'm not sure a taper from a full agonist really reduces the WDs all that much. The taper just resets the receptors to the new level, so WD can be pretty bad anyway. Take this all with a grain of salt.
 
Yes, I have considered using the suboxone for only 3-4 days if the WD is terrible. I am going to just see how I feel though. If it is manageable after 3-4 days, then I will just skip the suboxone all together and just ride it out. I have gone CT before, but it was usually after fairly high doses, and not after a decent taper. So I will just have to see. I can't imagine that the DT process would be the same from a low dose vs a high dose, but neither do I think it will be a walk in the park either.

Also, I am going to try to avoid the time release and stick to instant to try to keep the DT profile more for a short-term acting substance.

I have heard the same thing regarding the bupe DT not really taking full effect until 3-6 days, but it does sound like you have done a decent taper, and have not really been on it that long, so hopefully it will be much more manageable for you. However, this "core pain" you are referring to concerns me a bit. Is this a medical problem that is unrelated to the opiates / opiods, or do you believe it is the result of the DT from either the MS Contin or bupe?? We are rooting for you, and will be there if you need to talk. Feel free to PM me if you wish too.
 
Thanks for the response, VisceralChem. Going to short-acting seems a better plan than long-acting. I would really be interested in how it works out.

Yeah, I was actually put on this crap for pain after endless efforts to find something that worked. Finally got a series of treatments, semi-alternative, that got me to what I thought was 80% better. It was enough to start a wean down, which seemed to hold.

Problem that I have is there is still really core pain there, and my osteopath says it is certainly real/physical. All the muscles are spasming around the spot, and sedating myself with alternative meds is the only thing that releases it. The problem is that I don't know how much of this is the WDs and hyper-sensitivity of nerves post-opiates, and how much of this is going to be there when it is all done. Day 3 at zero and it remains tough. Any suggestions and support would be appreciated. Have to say I'm too new to know how to "PM". Looked for the acronyms here, but didn't find it. Thanks.
 
Hi NeedHelpWithSubs,

PM = Private Message = Click on my name and select "Private Message," or go to the "notifications" section at the top right of your screen, then "inbox" (works like email).

I am curious if they have definitely determined that this physical pain is real and severe, why then are they weaning you off the opiates in the first place? My stepfather has very severe physical pain, and decided he no longer wanted to take the massive amounts of opiates prescribed, and ended up finding great relief with medical marijuana, though admittedly this is not a viable solution for everyone (and if you do make sure the strain is for pain management - generally indica).
 
NeedHelpWithSubs - I can't send my reply to you via PM because your Inbox is full! You need to delete your messages in your "inbox" and/or "sent" box so that I can send you my reply! Please let me know when you have done so and I will resend it again.

Thanks!
 
Visceral,

It is super hard to judge how much Suboxone you should be taking especially since you haven't used it before to get off of another opioid. Speaking from experience, I was addicted to Oxy80's and Heroin for several years. I first was put on Suboxone, then Subutex, then Suboxone again. It all really depends upon your body. Some people need a little more or less than others do to successfully avoid withdrawal symptoms when attempting to wean or completely cut themselves off of Oxy/Heroin/etc. Your best bet, as most have said in response to your post, is to be on Suboxone for the shortest amount of time possible. But.... don't try to push/rush yourself too much as you could end up going back to straight up using again. 2-4 weeks on Suboxone isn't that long at all. It may seem so to some people, but in retrospect it's relatively short compared to most who are prescribed this Bupe. Taper yourself gradually and comfortably. Best of luck to you. I hope you're able to successfully kick that opioid habit. I know how fucking annoying and hard it can be.

Cheers
 
^^

Good advice.

You shouldn't base how long you're going to be on bupe by what other people say or somebody else's time table. You have to find what you are comfortable with and do it at your pace. A lot of people make the mistake of rushing to get off bupe because others have told them to or they've heard horror stories about bupe withdrawals etc, and they just end up back to using full time. So, be patient, stay on it for as long as you need to to, and then taper slowly and at a comfortable pace for you.

Better to do it right the first time, even if that means staying on it a little longer, than rushing to come off, relapsing, and then having to do it over again. That's how you end up just going back and forth from bupe to your DOC over and over again.
 
^^ I agree and think you both give some good advice. However, with my unique situation, I would just like to point out that my issue was that the side effects I was experiencing from the suboxone were almost equally as bad as the remaining withdrawal symptoms from the full agonist opiates, and therefore increasing the dose or doing a longer taper was not feasible. Increasing the suboxone resulted in increased side effects, reducing the suboxone resulted in increased withdrawal symptoms. Although I was initially afraid of being on it for a long period of time, it ultimately was not a deciding factor in rout I ended up deciding on.

Also, for discussions sake, it seems that most of the accounts I read where someone started off their suboxone experience with precipitated withdrawal ended up having a very bad experience with the suboxone - whether it was due to side effects or just lack of effectiveness. I should have probably done as Lorne suggested long ago and stopped the suboxone for 3-4 days sending myself back into acute withdrawal, then restarting the suboxone treatment over again, and could very well of had a more enjoyable and effective experience with it.
 
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