Precipitated Withdrawals or Bad Suboxone?

[justwannabefree]

I normally wait 24 hours after last dose of h and start my subs and have always been fine. This past week I tried induction and was sick despite trying 3 8mg strips of suboxone over about 6 hours. I took my first strip about 27-28 hours after last dose of h. I had just started to feel sick and took right away. I felt normal for about an hour or two and then I got pretty sick. Tried another strip, and an hour later another for a total of 3 whole strips over 6 hours. After waiting about 12 hours after first strip, I gave up and I dosed h again and it took quite a bit to feel normal (like 3x normal dose and still was meh til next day) now this weekend I want to attempt induction again.

I know what severe precipitated withdrawal is, one time, when I didn't know any better, I tried a sub 12 hours after last dose of h and went into severe withdrawals - it wasnt this bad (unless precipitated withdrawal can vary in degree depending how much h is still in your system)

The problem - I accidently left my subs hidden in a jacket under the seat of my car for a few weeks in summer 80 deg heat. They don't appear to be melted, faded, dry or cracked in any way. Is it possible I went through precipitated withdrawal but it wasnt as bad as that one experience since it was much later? Or is it more likely the subs are bad from the heat? I cant get more subs til after next weekend at earliest. I feel liie even if they were bad from heat they would work just be weaker? And I took too early? Whats a safe # to be on the COW sheet I see sooo many conflicting answers.

I realize any help is just suggestions since no one can no for sure, just wondering whats most likely since I never had this happen in the dozen times or so Ive done subs. I have found the COW sheet and will follow that for induction this time to be safe, although I see so many different recommendations for whats a good time to start /shrug. Thanks for reading and any help!

 

[FecklessFreckle]

I can't say whether or not your Suboxone went bad from the heat (perhaps you're right about it being weaker?), but I can tell you what my doc and nurse told me to do to get the best possible induction...

I was told to go with the number 26 on the COWS worksheet, so moderate to severe withdrawals, to get the best benefits from Suboxone and to make your induction a success.

Also a lot of people just keep taking more and more Suboxone when they don't feel it work right away and I've been told that's a huge no-no. The ceiling effect of Suboxone is 16mg and you'll not feel any real effects from it after that amount, just making your dependence way higher than it needs to be. I believe from 16mg to 24mg you only get about 20% of the effects (don't quote me, as I don't have my notes in front of me! Lol) So if you go into precipated withdrawals do NOT take more, though it's tempting. Just wait to get back to the 26 on COWS and try the induction again.

They suggested starting at 2mg, then waiting 60 to 90 minutes, taking another 2mg, waiting 60 to 90 minutes and continuing this pattern until you're not feeling the withdrawals anymore.

I've not started Suboxone yet so I can only go by what my doc and nurse at my Methadone clinic have told me. I've been picking their brains for the last 6 months and researching like crazy, so I can only go by what I've been told and read, not experience. Sorry. I hope it all works out for you!!

 

[justwannabefree]

Thank you for the reply.

I normally need 8mg when I first switch to Suboxone, 2mg just isn't enough for me personally - everyone is different. By the second or third day I usually can get away with taking 4mg and feel fine though and slowly start tapering off once stabilized.

I normally wouldn't just keep taking more strips when it doesn't work, but I was worried maybe it was damaged from the heat so I took more just in case it lost potency. But now looking back, I feel like even if it lost potency it should still work - just not as strong, so maybe I took too early. Unless it is so damaged the strips are completely bad?

I am giving it another shot and this time will follow the COWS worksheet. Hoping all goes well.

 

[Jabberwocky]

Technically speaking the ceiling dose of buprenorphine is something like 24mg, but this very often overkill. In situations where 24mg would be useful, another medication entirely like methadone would generally be more appropriate, even if it's just used for the acute detox.

But to answer your question OP, it's more likely minor precipitated withdrawal than your Suboxone going bad (it won't really do that). Even left in a hot car for a while shouldn't do too much damage to it. The thing with induction on buprenoprhine is that each time we induct it gets a little harder to induct again later on. It's hard to explain, but it's basically the same issue as how folks who are constantly switching from full agonists to Suboxone back and forth find the Suboxone to lose some effectiveness.

Let us know how it goes OP, and good luck!

p.s. it is also possible that there was something other than heroin in your heroin, as in a longer acting research chem opioid. If it isn't an issue of your metabolism changing as I suspect, that would be the most likely other reason for your recent unpleasant experience trying to induct.

p.p.s. Also, if you can find any tramadol, you can use that to more easily transition onto buprenorphine. Tramadol and buprenorphine/naloxone don't have any problematic interactions. Taking tramadol for a few days (depending on the opioid you're transitioning from, between 72hrs and a week) and then inducting directly onto buprenorphine/Suboxone while the tramadol is still in your system avoids precipitated withdrawal (buprenorphine/naloxone doesn't precipitate withdrawal in folks using tramadol IME) and provides for a more comfortable transition, avoiding having to let yourself go into full blown withdrawal before starting the buprenorphine. Problem is, most people can't easily find tramadol and it is still such a new protocol most doctors are unwilling to try it if they're not already familiar with it.

 

[cj]

I found the best success with a rapid induction by taking 1mg at a time. 1mg at the 24 hour mark followed by another mg every hour until I was satisfied.

 

[justwannabefree]

I found the best success with a rapid induction by taking 1mg at a time. 1mg at the 24 hour mark followed by another mg every hour until I was satisfied.

24 hours always worked for me as well. this time was different. like toothpastedog said maybe it was cut with something or could just be from repeated use causing harder induction or who knows. thanks for replying!

 

[justwannabefree]

toothpastedog - thank you for the response. its possible it was cut with something else, it is a reliable source but we all know that means little. unfortunately I dont know where to get tramadol. I do have clonodine I read that can help (not in the same way but still an aide)

I really hope I dont have to go to methadone, it would be really hard with my location and work. have my fingers crossed I dont have to go down that road.

I hope its not bad strips but Im thinking it was late precipitated wd. I will try again once wd hits and will follow cows this time. I will post back in a few days!

 

[Jabberwocky]

Good luck, we're rooting for you!

 

[justwannabefree]

Thanks! Did my last dose of h earlier today... just waiting for the sickness... oh joy! honestly cant wait for everything to be over. hopefully this time I stick it out for more than a month or two.

 

[Stargazer]

How'd things go? Hope transition was smoothe

 

[justwannabefree]

Had no energy for the past few days, starting to finally feel "normal". I had to wait nearly 52 hours before I felt ANY withdrawal symptoms (which makes me wonder if it was cut with something? not that it matters now...) but once I felt withdrawal coming on I took a strip and all was good. So for anyone wondering if heat destroys strips it seems to be ok - obviously avoid taking a chance though. Mine was in a car nearly the whole summer. Thanks for all the support and hopefully this really is the LAST time lol

 

[justwannabefree]

Well things were going well... til I got my paycheck and then I relapsed. I can be mad at myself but I know it happens. Ar least I decided to stop again before another few months or year went by. I am done with my last dose and will hopefully be able to start my induction before work on Tuesday morning. And then I have a fresh start again!

Is there anyway to speed up withdrawal onset? Whenever I search anything it just shows people trying to speed up withdrawal, I just want to make sure I can do induction of subs before work if possible. Like does excersize or anything help push the dope out faster? I never heard of anything and pretty sure its just giving it time.

 

[twang]

Not sure about speeding up withdrawal. That would be an awesome thing though because just the anticipation alone of sitting there waiting to feel really shitty so you can take your bupe is a terrible feeling. In my experience even if I waited the proper amount of time switch from H to bupe, I still felt super shitty for a couple days. Sorry to hear about your relapse. I have always hated thieves and have never stolen anything to get money for H, so being broke was one of the few things that could get me to switch from H to bupe. That was part of the reason I got onto bupe this most recent time. Although I was also very ready for it and was just waiting for an opportune time to get off dope being that I had a job and was in school. The last time I switched from dope to bupe it was entirely my own will and wanting a fresh start, but when I had saved up a few grand and was offered some VERY cheap roxi 30s my plan was to just sell them to make money. And after a few days of having them around I convinced myself to snort some by telling myself "my problem is with H, not Oxycodone, and I can financially afford to just do a couple of them" next thing I know I'm back on dope after about 5 months clean and the money I saved up during that time was gone in two weeks. Since getting clean this most recent time, I haven't managed to save any money at all because I'm not selling anymore. Apart from cutting all ties with everyone I know that associates with opiates besides a couple friends that sell bupe and not having an open air market, I think my being broke has been a, albeit small, contribution to my success. It's easy to rationalize using "just a little" when you get some money in your pocket. You just have to realize with opiates, once you're fully addicted, it's all or nothing. I've left sub strips in my truck for a couple months this summer, a very hot summer mind you, and even though it says to store somewhere 77 degrees fareignheight, the strips kept their integrity (no melting) and seemed to work just fine. I'm sure there was a little degradation but they still did their job.
Good luck getting clean this time, if you can bring yourself to do it (I never could until this last time) delete all your numbers in your phone that have anything to do with opiates. My insurance to that was also to tell all my dealers they were "little bitches" and told them "I never liked you, I always thought you were a fuckin pussy" and other stuff like that, so that way after they said similar stuff back and got their own verbal abuse out of their system, they would never text me or call me again so after I deleted their numbers I wouldn't have a way to get in contact with them again. One of them eventually contacted me like a month later and said he knew I was just saying that because I was withdrawaling and if I "ever need anything to hit him up", so I had to come back even harder than the first time and really laid into him and made him feel stupid for thinking that I was saying that stuff without really meaning it. I haven't heard from him since and by cutting off ties with everyone else involved with opiates I have no way of finding a new dealer. When you're not around people that use opiates, finding a heroin dealer in your everyday life, at least in my city, is a very unlikely thing.

 

[justwannabefree]

Thanks for the reply. Being broke does make it easier. I know I can get and stay clean, I've done it before... just a matter of actually putting on my big boy pants and doing it again. When I went and relapsed after I got my check it was just out of habbit and I should have had my parents held my check. Usually I have them hold the first few weeks and just give me a little cash for spending which I put on a prepaid card

Sometimes it can take a few days to feel "normal" on bupe. I usually feel normalish right away if induction goes smoothly. its not just the right time but the right numbers on the COWS worksheet that you want before starting induction. also you may want to start with a tiny dose and keep adding as necessary. taking a whole strip or two adds likelihood of precipitated wd symptoms

I havent been able to find anything about bringing on withdrawal faster, its only keeps showing results to get *through* withdrawal faster which isnt what i want!

We often lie to ourselves and rationalize things. Us dopeaddicts are the best liars, rationalizers, and manipulators... not just of others but also to ourselves... This wasnt the case of that though, it was just wanting to use so I did. And afterwards I felt really shitty about it and had instant regret. But I have lied to myself and rationalized insane things before in the past, like when you said you would only sell the 30s and not use them, and they are different from dope. As you learned, dope 30s oxy are all different heads of the same dragon.

I actually won't delete my contact numbers when I get clean because theres no point. First I live near 2 cities with open air markets but its very risky to grtting robbed / ripped off / arrested / dead. So if I'm gonna relapse Id rather be "safer". Plus with my closest connect I know his number by heart and could get it from a couple friends or relatives if needed. I wont hang out with people who use when I am clean, but I have a lot of lifelong friends and some family members and relatives who are addicts. If I threw away my phone and car I could still have dope within 30 mins easily. I have to want to stop and have to make the effort - I cant just try avoiding it, it will always be there around me. Around here people who dont even use drugs run into people selling dope and "perks" all the time.

I am still surprised and blown away that bupe held up in a car for weeks in the summer (on a 90 degree day a car is well over 100 deg!) but that stuff is very resilient! That was a huge blessing to me, if I lost all those strips it would have made things a little more complicated or had to wait a couple weeks more

 

[twang]

To me it seems the easiest way to get clean and stay clean would be to move to a completely different city, one that isn't known for open air markets or opiate abuse, and where you don't know anyone at all. I wish I could have done that but most addicts in early recovery can't afford such a thing. For a short time when I actually had a decent amount of money and was using I went and got a passport and had planned on going to a tropical island in the South Pacific to get through the first couple weeks of WD and have beauty all around me to ease into it. I second guessed the decision and decided not to do it though.

 

[Jabberwocky]

The only way to really speed up the onset of acute withdrawal is to induce it via an opioid antagonist, and you really really really don't want to do that (it's very hard on the mind-body). In other words, precipitated withdrawal.

Staying busy or, conversely, sleeping/lazing through the pre-induction period is how I'd normally deal with it. Basically it's a matter of passing the time.

Perhaps you could try using this as an oppertunity to explore what about all this is most alive for you, as the kind of patience it takes to get through the pre-induction period is essentially the same kind that is so helpfully when working on our recovery.

 

[justwannabefree]

thanks for the replies!



Toothpastedog - I was afraid that there was no way to speed up the onset of withdrawal. Waiting for withdrawal isnt an issue for me (well its not enjoyable but I can tolerate it). I was just hoping to have withdrawal start early enough that I can do my induction before work on Tuesday. Based on the time it looks like I might have to do it at work which I was hoping wouldnt happen. its not a huge deal though, Ill manage.

But usually I like to just lay around and be lazy prewithdrawal. I may sleep if I can, and if not I'll just be lazy and rest or maybe watch TV/movies or read a book. Youtube is always a big help for me. If my anxiety starts bothering me then I will try to get out of bed and do something to keep myself busy. Watching the clock is a bad idea if anxiety is kicking.


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twang - if I had the money I would love to go stay somewhere for a few weeks. you cant outrun addiction though - i have tried and so have many others, even at a new place if you want it bad enough you will still find a way to find your DOC. you have to want to quit.

But while I could take a vacation, I cant move somewhere else with my job, place, family and friends.. plus lack of money.. I just couldnt do it at this stage of my life. if I was younger maybe I would try it. while I cant move away, I would absolutely love to go to a relaxing or tropical place for a shortwhile to get passed the first few weeks. I just wish I had the funds to do so. I even have almost a month of saved vacation time saved up at work (can never afford to go on vacation as a addict so have many saved days - all my sick days are gone though lol)

 

[twang]

Nothing makes time go by faster than sleeping, for me anyways. Xanax also makes time go by faster, even while I'm awake. Plus it inevitably makes me fall asleep...close your eyes one minute, open them the next, and all of a sudden it's 12 hours later. I understand you can't run from addiction, those were just my personal plans to set myself up for success. Even with a raging desire to be clean, it's so hard that I wanted to give myself every advantage I possibly could

 

[Jabberwocky]

If you can get it tramadol allows for a super comfy transition onto buprenorphine. And gabapentin helps a lot, basically any non-opioid comfort med (so gabapentin, baclofen, clonidine, diazepam, clonazepam, sleep meds, hell even DXM - though don't expect to be at all functional).

The most comfortable transition I've ever had actually involved taking DXM for a couple days and then starting buprenorphine. Totally blew my mind. For a lot of people (most people), DXM is a very unpleasant thing. But something about acute opioid withdrawal makes it more "enjoyable." Just watch out for those farts from hell

Something that is so incredibly frustrating for me is that, almost without exception, doctors make their patients suffer through the transition and induction. Appropriately prescribed comfort meds are not only entirely safe, but they don't do anything except alleviate unnecessary suffering.