Scared of Bupenorphine Withrawl any Advice?

[Loree]

Hi,

My doctor is currently prescribing 4mg a day and 10 extra to take as needed for pain. I had almost an entire extra bottle from a previous refill so I am taking 3 on many days but without any schedule.

I've been super depressed, lethargic, apathetic and crying too much. I suspect part of this is the Bup which I take for pain. I will deal with the pain because this stuff is strong and I've been on it going on 2 years. I was on it for about five years ago for under 4 or 5 months and it was very hard even then to quit. I think I tapered too quickly. I

I shouldn't have started again but with pain, a break-up and all at first it really helps my depression and energy. Its just so damn hard to get off of I appreciate any advice that can make it easier.

Unless someone has gone through it they just don't understand. I would never wish any suffering on someone, but its nice to know you're not the only one who has or is facing similar challenges.

Thank you....

 

[mtu mwendawazimu]

Hey @Loree - welcome to Bluelight!

So im going to shoot this over to Health and Recovery where you might get more replies.

I hope someone who has first hand experience with this drug can help you out.

I have no idea what it's like, but i wish you a speedy recovery.

Peace and love.

 

[Deru]

My doctor is currently prescribing 4mg a day and 10 extra to take as needed for pain. I had almost an entire extra bottle from a previous refill so I am taking 3 on many days but without any schedule.

In order to offer you better advice, I just need to clarify your dosage.

You’re prescribed one 4 mg Suboxone per day, with an extra ten 4 mg Suboxone to take as needed?

And then with the extra bottle from previous refill, you’re taking three 4 mg Suboxone (12 mg total Suboxone daily) on most days?

 

[HoldBack]

Hi,

My doctor is currently prescribing 4mg a day and 10 extra to take as needed for pain. I had almost an entire extra bottle from a previous refill so I am taking 3 on many days but without any schedule.

I've been super depressed, lethargic, apathetic and crying too much. I suspect part of this is the Bup which I take for pain. I will deal with the pain because this stuff is strong and I've been on it going on 2 years. I was on it for about five years ago for under 4 or 5 months and it was very hard even then to quit. I think I tapered too quickly. I

I shouldn't have started again but with pain, a break-up and all at first it really helps my depression and energy. Its just so damn hard to get off of I appreciate any advice that can make it easier.

Unless someone has gone through it they just don't understand. I would never wish any suffering on someone, but its nice to know you're not the only one who has or is facing similar challenges.

Thank you....

Some people are able to really separate the withdrawals from their feelings and fear of withdrawal and do a long slow taper.

however, I think I am more like you. That is, so afraid of withdrawal that I mentally make it worse than it is.

unfortunately, your options are limited. If you are losing your rx, you will need to go through the withdrawal.

I’m a big advocate of methadone. Some patients find it especially effective for pain. But again, it will only serve to stave off the inevitable and likely make it worse.

 

[Jabberwocky]

unfortunately emotional instability is an integral part of opioid withdrawal. you haven't been feeling and therefore processing shit while you've been using, but you do need to process that stuff so it is just sitting there waiting for you when you stop using. the good news is that it sounds like you haven't been doing this too long, so you shouldn't have too much in the post (i had 6 years worth when i got clean never thought it would end!!). there isn't really an easy way out, you just have to go through it. stay strong and remind yourself, this will end.

if you have chronic pain issues i would ask your doctor about potential non-opiate options, and look into mindfulness to complement your meds, it might sound like woo but the science is solid.

 

[mrpopper]

I've done bupe withdrawal. About six months ago. I was on 8mg a day. I split up the last six or so pills into halves, then quarters. I had only been on them for two or three months though, not two years!

It is doable. If you can get hold of a few co-codamol pills they will help.

It was by no means pleasant. But not too bad. I had two or three weeks of only sleeping two or three hours a night, and the usual mild aches and pains.

I've experienced bupe withdrawals, heroin withdrawals, and methadone withdrawals, and if I had to choose one of the three, it would definitely be buprenorphine.

Please don't go on to methadone instead. That is definitely out of the frying pan and into the fire. Methadone withdrawals are the worst by far. Worse than heroin.

It can be done. Good luck.

 

[TheInvisibleStoner]

Please don't go on to methadone instead. That is definitely out of the frying pan and into the fire. Methadone withdrawals are the worst by far. Worse than heroin.

That isn't true. Bupe withdrawals are actually longer than methadone. My experience with it even taking it for a few weeks here and there are that its a VERY potent opiate, and the withdrawals are closer to a fast acting opiate. The nausea, and vomiting are bad. Never puked once from methadone withdrawal, which includes countless cold turkey withdrawals off doses up to 80mg.

Also you can do a methadone taper fully controlled. All the way down to a tiny drop. Bupe is hard to taper since you are given a large amount. Dosing is strange as it seems the less you take the more you feel. Would imagine trying to come off a long term bupe habit would be a cluster fuck.

I tapered methadone (was over 100mg for a bit on this run) down to 3mg once slowly over 2 years and had the most mild withdrawal ever. Worked full time through it even without even missing but a day or two from work. Was feeling fine in 2 months, by 6 months was feeling better than ever. But I also hadn't touched dope in years. Wasn't drinking, and was eating and exercising. Even on a methadone taper, only takes using dope (or any powerful opiate) a few times to completely throw you off and de stabilize you.

Bupe is just a strange drug. I never got pain relief from it. It actually caused pain. Would not recommend my worst enemy to take this stuff. It also sucks since it blocks natural endorphins, and even takes them out of you. Not a drug to take for more than a few days imo. In a few years we are going to start seeing more and more studies on it.

All the horror stories you hear about methadone are people that pushed their dose to obscene levels, stayed on it for years and years, then came off too fast. Methadone withdrawal is very mild when tapered correctly (no more than 10% of your dose per month with added stabilization from time to time).

Not recommending the OP to switch to methadone. But if bupe is not working, you have pain, depression, and would like a controlled taper....its something to consider.

For now you need to get on the same dose of bupe. Take it once a day, and come down slowly in .25 increments. I know lots on bupe dose multiple times through the day. This would lead to serious dependence. Kinda like when you are dosing heroin every few hours. You will be getting sick earlier since your body is expecting it. There was a time in my life I was getting dope sick just after a few hours, this was no doubt since I was dosing so often. Perhaps you may need bupe 2x daily, but keep it always at the same time, same dose.

I don't know what these doctors are thinking. 4mg and take more if you like? That would be like being on 50mg of methadone, and them giving you 100mg on the side to take as needed. Would never happen since goes against the whole point of maintenance. And that is to be stable. Why I believe methadone can actually heal the brain when done right. Its the constant up / down cycle that fucks your brain up. When you are stable giving your body the same dose, at the same time daily, your body will adjust. And then slowly removing it, your body will adjust this way too.

 

[mrpopper]

That isn't true. Bupe withdrawals are actually longer than methadone. My experience with it even taking it for a few weeks here and there are that its a VERY potent opiate, and the withdrawals are closer to a fast acting opiate. The nausea, and vomiting are bad. Never puked once from methadone withdrawal, which includes countless cold turkey withdrawals off doses up to 80mg.

Also you can do a methadone taper fully controlled. All the way down to a tiny drop. Bupe is hard to taper since you are given a large amount. Dosing is strange as it seems the less you take the more you feel. Would imagine trying to come off a long term bupe habit would be a cluster fuck.

I tapered methadone (was over 100mg for a bit on this run) down to 3mg once slowly over 2 years and had the most mild withdrawal ever. Worked full time through it even without even missing but a day or two from work. Was feeling fine in 2 months, by 6 months was feeling better than ever. But I also hadn't touched dope in years. Wasn't drinking, and was eating and exercising. Even on a methadone taper, only takes using dope (or any powerful opiate) a few times to completely throw you off and de stabilize you.

Bupe is just a strange drug. I never got pain relief from it. It actually caused pain. Would not recommend my worst enemy to take this stuff. It also sucks since it blocks natural endorphins, and even takes them out of you. Not a drug to take for more than a few days imo. In a few years we are going to start seeing more and more studies on it.

All the horror stories you hear about methadone are people that pushed their dose to obscene levels, stayed on it for years and years, then came off too fast. Methadone withdrawal is very mild when tapered correctly (no more than 10% of your dose per month with added stabilization from time to time).

Not recommending the OP to switch to methadone. But if bupe is not working, you have pain, depression, and would like a controlled taper....its something to consider.

For now you need to get on the same dose of bupe. Take it once a day, and come down slowly in .25 increments. I know lots on bupe dose multiple times through the day. This would lead to serious dependence. Kinda like when you are dosing heroin every few hours. You will be getting sick earlier since your body is expecting it. There was a time in my life I was getting dope sick just after a few hours, this was no doubt since I was dosing so often. Perhaps you may need bupe 2x daily, but keep it always at the same time, same dose.

I don't know what these doctors are thinking. 4mg and take more if you like? That would be like being on 50mg of methadone, and them giving you 100mg on the side to take as needed. Would never happen since goes against the whole point of maintenance. And that is to be stable. Why I believe methadone can actually heal the brain when done right. Its the constant up / down cycle that fucks your brain up. When you are stable giving your body the same dose, at the same time daily, your body will adjust. And then slowly removing it, your body will adjust this way too.

I guess a lot of this stuff is very subjective, but in my experience methadone withdrawal was much worse. It was one of the worst moments in my life.

Plus a know a lot of people who have the same experience, but you're right in that I think pretty much all of those people had been on methadone for years on end.

I'm currently in heroin hell myself and trying to quit. If I go to see rehab people, in the UK we're given a choice of going on methadone or buprenorphine and due to my past experience, I'l choose the latter, no doubt at all.

 

[TheInvisibleStoner]

Yeah, if you are dosing at 120mg for years on end, you will be in deep shit.

One day I will open my own clinic. Nobody will be getting 120mg aside the most hardcore addicts. And nobody will be staying on it for anything more than a year or two aside the most hardcore addicts (2 decades of abuse, etc). They let 18 year old kids come and dose for years and years. Definitely not helping them. The first time I started a clinic was 20. I fell into the trap of letting my dose get to 80mg. Once the 1st few months of the glow wore off, I knew something was wrong so just stopped. Went straight back to dope, and oh man the dope withdrawals were the worst I felt. Luckily went to jail not much longer, but was still sick 60 days later. High dose methadone is very bad. Especially when combined with IV heroin.

 

[MrsGamp]

sorry you are in such a bad way....
this doesn't work for everyone but I stopped hard painers by using Tramadol. It seemed to help me by pass the worst of the WDs. It's not as hard to get a script for.
Like I said it doesn't work for everyone ... quite a few people say Tramadol either does nothing at all, or even makes them sick.
But it gives me a mild lift and ok pain relief too!

 

[JessFR]

Yeah, if you are dosing at 120mg for years on end, you will be in deep shit.

One day I will open my own clinic. Nobody will be getting 120mg aside the most hardcore addicts. And nobody will be staying on it for anything more than a year or two aside the most hardcore addicts (2 decades of abuse, etc).

Then I am 100% your clinic would destroy my life. Because if I were forced off methadone I'd go straight back to heroin. No question about it. Being honest I'm exceptionally glad you're not in charge of these things. Methadone has saved my life, and destroying it again for no reason but some belief in sobriety as the only goal of addiction treatment is extremely misguided.

I get that it's coming from a place of good intentions. But it should be up to the addict to decide when they're ready to get off methadone, and indeed if they ever are.

I do agree though that it's extremely unusual someone really needs more than 120mg of methadone, and unless there are clinical symptoms of withdrawal, most people probably shouldn't be on more than that.

Most people, it is still something that should be handled case by case.

 

[Deru]

Then I am 100% your clinic would destroy my life. Because if I were forced off methadone I'd go straight back to heroin. No question about it. Being honest I'm exceptionally glad you're not in charge of these things. Methadone has saved my life, and destroying it again for no reason but some belief in sobriety as the only goal of addiction treatment is extremely misguided.

I'm incredibly torn on maintenance management after everything I went through since 2017.

If we were talking in 2016, I would have agreed with you 110%. I thought I would be an opioid addict until the day I died, I accepted it and that was that. Without opioids, I couldn’t function and I would purposefully incorporate self-destructive behaviors until I found them.

In hindsight, I’m so incredibly grateful that I have found life again free from them. It wasn’t easy, and without everything that happened, I’m not even sure if it would have been possible for me. What I do know, though, and was pleasantly surprised with, is what I found as “normal” from exogenous opioids to function, once my endogenous opioids normalized I feel even better than I ever could have on my best day as an opioid addict. I can wake up in the morning and be swimming in opioids, no sickness, and just lay in bed and just.... be. If I’m feeling tired or pain, I go to the gym or exercise at home, and I can swim in my own endogenous opioids whenever I want to.

Another caveat with maintenance, is there is the constant trigger associated with continual usage of the maintenance opioids. I was never able to escape it my entire decade on buprenorphine.

I find it saddening that treatment is starting to shift to emphasizing long term treatment versus short term, and extremely high doses, because it ultimately casts a wide net and a lot of people becoming larger addicts going into treatment than they were prior. I know the argument is to be made that it allows them time to sort out the behavioral issues, and that’s excellent and required, but with the shift to potential life long maintenance, there seems to be no reinforcement for doctors to create the nuanced care to transition patients to sobriety anymore, and I find that unacceptable considering how advanced our medical advances are.

I don’t understand why the treatment industry doesn’t emphasize diet, nutrition, exercise, the essentials required to be healthy and happy sometimes. There really is nothing we can’t achieve if we feed our bodies what we need to be operating at peak performance, and of course, a little love and friendly guidance along the way.

 

[JessFR]

I'm incredibly torn on maintenance management after everything I went through since 2017.

If we were talking in 2016, I would have agreed with you 110%. I thought I would be an opioid addict until the day I died, I accepted it and that was that. Without opioids, I couldn’t function and I would purposefully incorporate self-destructive behaviors until I found them.

In hindsight, I’m so incredibly grateful that I have found life again free from them. It wasn’t easy, and without everything that happened, I’m not even sure if it would have been possible for me. What I do know, though, and was pleasantly surprised with, is what I found as “normal” from exogenous opioids to function, once my endogenous opioids normalized I feel even better than I ever could have on my best day as an opioid addict. I can wake up in the morning and be swimming in opioids, no sickness, and just lay in bed and just.... be. If I’m feeling tired or pain, I go to the gym or exercise at home, and I can swim in my own endogenous opioids whenever I want to.

Another caveat with maintenance, is there is the constant trigger associated with continual usage of the maintenance opioids. I was never able to escape it my entire decade on buprenorphine.

I find it saddening that treatment is starting to shift to emphasizing long term treatment versus short term, and extremely high doses, because it ultimately casts a wide net and a lot of people becoming larger addicts going into treatment than they were prior. I know the argument is to be made that it allows them time to sort out the behavioral issues, and that’s excellent and required, but with the shift to potential life long maintenance, there seems to be no reinforcement for doctors to create the nuanced care to transition patients to sobriety anymore, and I find that unacceptable considering how advanced our medical advances are.

I don’t understand why the treatment industry doesn’t emphasize diet, nutrition, exercise, the essentials required to be healthy and happy sometimes. There really is nothing we can’t achieve if we feed our bodies what we need to be operating at peak performance, and of course, a little love and friendly guidance along the way.

In medicine recommendations are based on statistics.

The statistics on methadone are pretty clear. The longer people's are on it the better they do. When they get off it the relapse rate goes up. Deaths go up. Crime goes up.

So of course they will recommend you stay on it.

Different people have different psychologists and will benefit from different approaches.

But I have absolutely zero doubt that if I hadn't gotten on methadone, I'd still be using heroin, Id still be begging for money or stealing or prostituting. IF I wasn't dead or in jail.

Methadone is what allowed me to turn it around. And I have zero doubt that if I were made to get off it that inside of a month or so if be right back where I started.

Maybe one day I'll be ready to get off opiates. But that time will come when it comes.

Im not saying people are wrong to use treatments other than methadone, not at all. I am saying that methadone has helped a lot of people and together with buprenorphine represent the most effective addiction treatment we have going by the data.

And it infuriates me when people who insist everybody follow their way of addiction treatment. That shit gets people killed.

Not saying you're doing that, but the post I replied to sure seemed too.

 

[TheInvisibleStoner]

Then I am 100% your clinic would destroy my life. Because if I were forced off methadone I'd go straight back to heroin. No question about it. Being honest I'm exceptionally glad you're not in charge of these things. Methadone has saved my life, and destroying it again for no reason but some belief in sobriety as the only goal of addiction treatment is extremely misguided.

I get that it's coming from a place of good intentions. But it should be up to the addict to decide when they're ready to get off methadone, and indeed if they ever are.

I do agree though that it's extremely unusual someone really needs more than 120mg of methadone, and unless there are clinical symptoms of withdrawal, most people probably shouldn't be on more than that.

Most people, it is still something that should be handled case by case.

It would be case by case. My clinic would not fuck any life up.

But you wouldn't be allowed to just roam free. We would need to figure why you think you need to dose up to your choosing. Thats all.

lol like i have a clinic. Maybe one day.

 

[JessFR]

It would be case by case. My clinic would not fuck any life up.

But you wouldn't be allowed to just roam free. We would need to figure why you think you need to dose up to your choosing. Thats all.

lol like i have a clinic. Maybe one day.

And what about your time limit? Because that was my main complaint. Saying people should only be in methadone for a set time.

That's far more destructive and dangerous than a 120mg dose limit.

But as for what dose people should be on, it's a lot safer to let people get above what they need than force them to stay on less than they need. Because if you aren't given enough to control your withdrawal, you'll likely just relapse.

So the question is how do you determine how much they need, and I don't see how you reliably do that without risking people winding up on more than they need. Way I see it you just have to explain why that would be a bad idea and hope they choose to stop.

I did, once I reached 80mg I felt that was enough that I wasn't experience symptoms or cravings, and I said I didn't want to increase it further.

 

[wudbutcher]

Then I am 100% your clinic would destroy my life. Because if I were forced off methadone I'd go straight back to heroin. No question about it. Being honest I'm exceptionally glad you're not in charge of these things. Methadone has saved my life, and destroying it again for no reason but some belief in sobriety as the only goal of addiction treatment is extremely misguided.

I get that it's coming from a place of good intentions. But it should be up to the addict to decide when they're ready to get off methadone, and indeed if they ever are.

I do agree though that it's extremely unusual someone really needs more than 120mg of methadone, and unless there are clinical symptoms of withdrawal, most people probably shouldn't be on more than that.

Most people, it is still something that should be handled case by case.

This fascinates me. At what point is a refusal to taper to nothing simply psychological? I’ve read on here folks that still take methadone for years. At what point Does it seat to be anything more than continued opiate use? And yes, I get that it’s better than sticking a needle in your arm or taking chances with inconsistent product from the street. I just wonder if it wouldn’t be similar to an alcoholic taking a daily thimble full of liquor.Seems counterproductive, and a recipe for relapse if the stars align. Don’t get angry Jess, I’m sure I worded it incorrectly. Not as eloquent with keystrokes as face-to-face my apologies

 

[Deru]

I'd agree with you on most of your points.

Pros and cons, and without a doubt some people may need years to fully get to a place where they're ready to get off.

There seems to be something... lacking ... in the spectrum between long term and life long, though.

And, yes, I'm aware what the data shows and why the approach is shifting from short term to long term. I still believe the treatment industry has the power (and responsibility) to ultimately affect the outcome and trajectory their patients take after they start treatment.

Do you agree it seems problematic the fundamentals like diet and exercise aren't emphasized more?

Or that doctors have increased incentives to protect themselves by keeping patients on maintenance medication, and extremely high doses, longer than they may need to, out of fear to protect themselves?

Just things I think about a lot in hindsight of everything I went through in my life, I really would like to see positive changes that truly help us all in those times in our life find a healthy and happy path forward.

 

[JessFR]

This fascinates me. At what point is a refusal to taper to nothing simply psychological? I’ve read on here folks that still take methadone for years. At what point Does it seat to be anything more than continued opiate use? And yes, I get that it’s better than sticking a needle in your arm or taking chances with inconsistent product from the street. I just wonder if it wouldn’t be similar to an alcoholic taking a daily thimble full of liquor.Seems counterproductive, and a recipe for relapse if the stars align. Don’t get angry Jess, I’m sure I worded it incorrectly. Not as eloquent with keystrokes as face-to-face my apologies

The question I think that has to be asked here is, what is the goal?

What is the fundamental purpose of addiction treatment. Because the answer to that question influences everything about what approaches should be used.

Way I see it, the goal absolutely is NOT to get off opiates. That is a means to the real goal. That goal being to be a functional adult in adult society. To be able to hold a job, not commit crime, not wind up killing yourself, not end up in jail.

That's the goal. Sobriety is simply one means to achieving that goal.

It is folly to expend effort trying to get people off opiates if they are functioning very well on them, and would certainly function less well as a consequence of getting them off opiates.

The statistics show the longer people are on methadone the better they do, and I can totally understand why. I know me, I am under no illusions about my addiction. I am not ready to get off opiates. If I were, I would be asking to start tapering off my methadone. I'm not.

And trying to force me to be, I am absolutely certain, would result in a severe deterioration of my ability to function in the world. It would damage my life, and my health. And for what? For absolutely nothing. Since I wasn't gonna stay off opiates entirely anyway.

Not everyone is like me, but a lot of addicts are.

The data is clear,people are much more likely to relapse when they get off methadone, even if it's their choice to do so. Than they are while still on methadone.

Way I see it, you have to be realistic, not idealistic. Not everyone is gonna get clean, not everyone is gonna get clean soon.

The goal is to help them to the best extent possible within the realistic parameters available.

 

[wudbutcher]

The question I think that has to be asked here is, what is the goal?

What is the fundamental purpose of addiction treatment. Because the answer to that question influences everything about what approaches should be used.

Way I see it, the goal absolutely is NOT to get off opiates. That is a means to the real goal. That goal being to be a functional adult in adult society. To be able to hold a job, not commit crime, not wind up killing yourself, not end up in jail.

That's the goal. Sobriety is simply one means to achieving that goal.

It is folly to expend effort trying to get people off opiates if they are functioning very well on them, and would certainly function less well as a consequence of getting them off opiates.

The statistics show the longer people are on methadone the better they do, and I can totally understand why. I know me, I am under no illusions about my addiction. I am not ready to get off opiates. If I were, I would be asking to start tapering off my methadone. I'm not.

And trying to force me to be, I am absolutely certain, would result in a severe deterioration of my ability to function in the world. It would damage my life, and my health. And for what? For absolutely nothing. Since I wasn't gonna stay off opiates entirely anyway.

Not everyone is like me, but a lot of addicts are.

The data is clear,people are much more likely to relapse when they get off methadone, even if it's their choice to do so. Than they are while still on methadone.

Way I see it, you have to be realistic, not idealistic. Not everyone is gonna get clean, not everyone is gonna get clean soon.

The goal is to help them to the best extent possible within the realistic parameters available.

Might I ask, pain or recreation?

 

[JessFR]

I'd agree with you on most of your points.

Pros and cons, and without a doubt some people may need years to fully get to a place where they're ready to get off.

There seems to be something... lacking ... in the spectrum between long term and life long, though.

And, yes, I'm aware what the data shows and why the approach is shifting from short term to long term. I still believe the treatment industry has the power (and responsibility) to ultimately affect the outcome and trajectory their patients take after they start treatment.

Do you agree it seems problematic the fundamentals like diet and exercise aren't emphasized more?

Or that doctors have increased incentives to protect themselves by keeping patients on maintenance medication, and extremely high doses, longer than they may need to, out of fear to protect themselves?

Just things I think about a lot in hindsight of everything I went through in my life, I really would like to see positive changes that truly help us all in those times in our life find a healthy and happy path forward.

It's not the job of doctors or addiction treatment to tell people how to live their life. It is their job to help people live their life in more healthy ways.

That is why punitive or forceful approaches shouldn't be used, on top of being less effective.

Should they emphasize other aspects of healthy living than just staying off drugs? Yes of course they should.

There's a lot more to recovery than just stopping the drugs. There's rebuilding nondrug support networks, stabilizing housing, getting untreated chronic illnesses treated, securing an income via a job or something. And much more.

And yes, people in treatment should be encouraged and aided to do all those things I agree.

But it's on top of, not instead of, the underlying approaches to treating the addiction. Which include substitution therapy, detoxes, rehab, and other approaches to getting clean which have greater or lesser success with different people depending on the kind of person they are and where they are in their life at the time.