Opioids Suboxone as a Middle Step in a Taper?

[ValaisFendant]

Hi -

I have decided to bring my escalating habit under control. I have chronic pain, and after frustration with doctors who only suggested NSAIDs and spinal cortisone, I took matters into my own hands. I have been treating the pain for 5 years with oxycodone and oxymorphone. The amount I was consuming recently had become extreme (500mg oxycodone equivalent per day) ... far more than needed to control pain.

My goal is to taper my consumption drastically, and then develop a longer term plan for pain management with my physician (who only this week was let “into my tent”, and who, thank god, seems more open minded to a wider range of treatment options). But I want to do a lot of the taper on my own, before relying more heavily on my doctor.

In the first week since I decided enough was enough, I cut consumption to less than half, with noticeable but relatively mild side effects (some trouble sleeping, some extra sweating, but nothing like a cold turkey withdrawal). From 500mg six days ago, I dropped down to 210mg yesterday. I know that soon, the slope of the taper will need to shallow. I have been taking as little as possible to keep side effects tolerable, and 210 just happens to be where I got after six days.

I have four dissolvable 8/2 suboxone films and was wondering if there would be benefit in using the suboxone as an intermediate step in a taper.

The basic idea would be to use one of the films:
- Take a last dose of oxycodone a couple hours before bed tonight
- Develop mild to moderate withdrawal symptoms
by morning (10 hours or so)
- Dose Suboxone in the morning... the lowest amount needed (would 4mg be a reasonable dose?)
- Take Suboxone for a couple more days... say 2mg on day 2 and 2mg on day 3? I don’t know if this is reasonable or not.
- Wait for withdrawal symptoms to return, and go back to using Oxycodone ...

At that point, would I be able to get by on a meaningfully lower dose of oxycodone,
to continue the taper? Say, from 210mg now, to something more like 80mg or 120mg?

I don’t understand how Suboxone works in terms
of impacting tolerance.

Does taking Suboxone for 3 days basically tell your brain you took zero oxycodone for 3 days and thus you need a lot less of it... or does tolerance not change because it’s just one drug for another?

That’s the crux of the question, really. How does
bupe impact tolerance to opiate agonists when used for a short time

If this strategy sounds stupid, or unnecessarily complex, I want to explain a few things:
1) I want the latter parts of the detox to be spread out over a fairly long time. I have not had good luck going cold turkey. I am just trying to get to the “late innings” as quickly and comfortably as I can.
2) I am afraid of using Suboxone for a long term taper as Suboxone itself is hard to withdraw from thanks to its half life.
3) I don’t want to get medical professionals involved until I have made significant progress on my own. I want them to treat me as a fighter not as a junkie who lacks all semblance of self control.

Any thoughts?

If Suboxone as a middle-step is a bad idea, I will stick with a normal taper instead. It would be nice to have something that works for more than a few hours at a time though.

-VF

 

[Jabberwocky]

Hello and welcome to Bluelight!

It's good to see that you want to drastically change your opioid intake, but I think you are in a hurry a little bit. You need a little more patience, you did a huge drop in just 6 days, but now that you are fine with it it's ok just in the future do smaller ones so adjustments are easier to do when certain side effects appear.

Is staying only on oxy a problem for your GP? I think you could stay on the oxy and avoid the suboxone, cut down the oxy until you reach a dose for pain management. I think it's not wise to let these matters only in your hands anymore, involve your doc more. All alone you got yourself to 500mg, it's not shameful to ask for help, it's only natural.

Sub withdrawal, when you would want to leave that too, will last longer than the oxy one, oxy has shorter half-life and you could use IR versions for breakthrough pain and ER for maintanance.

You are on 210 mg now, could you drop 20 mg per week? like on every monday you take 20mg less, it's gonna be a long drawn out process but it's designed like this to make the transition comfortable.

By the way since you are new in the future if you'll want to not only cut the doses lower but to give up entirely I recommend checking out the Health & Recovery Subforums or the Dark Side Subforum. And when you got some time check out the Bluelight User Agreement to make posting easier for you. Stay safe and have faith, you'll go through this smoothly, with our help, your will and your GP's supervising you'll get the desired results.

 

[Chris42393]

Doctors are trained to taper their patients 10% of their total dose each week (its quite a long process if you use a high dose). But it makes withdrawing pretty easy (each person is different though obv.)

For me, I wouldn't touch Suboxone with a 10-foot stick. When I came off heroin, I used Kratom and gabapentin (never used both at the same time though).

I quit taking my H completely and then just Kratom 3-4 times daily (for a total of 10-12grams). After that, I just tapered that down and was finally off all opiates. I pretty much had ZERO withdrawals as well. My Doc also prescribed me Gabapentin. Just with that, I had zero withdrawals. I took that 3 times daily as well and felt great.

 

[FutureReference]

As stated above by morpheus, the half-life of Suboxone is insane. Buprenorphine with a half-life of 36 hours was the worst withdrawal I have ever been through. Oxy withdrawals are terrible but literally a walk in the park in comparison. It is like a common cold compared to a month-long sleepless flu.

If this is for pain but got out of hand, why not speak to a Pain doctor and get onto a reasonable dose? You have already realized your dose was way too high but cut it substantially? While I did feel Suboxone reset my receptors in terms of full opioids, it may go against your desires here. When I got off of it, my Oxy felt stronger this the desire to keep taking more increased. Unless you want to commit to no more full opioids I would stay away from the Suboxone.

Pain and addiction go hand-in-hand but you desire to live a life free of pain or at least as close as possible! I hope you can see a doctor and get on a dose of Oxycodone that helps with your pain. I used to be on both Oxycodone and Hydromorphone and now my prescribed dose is so low I still have pain but it is better than no help at all. Wishing you the best man

 

[ValaisFendant]

Thanks all for the replies

Quick update - over the last month I have tapered from 500mg down to around 150mg oxy equivalent per day. I actually did 125mg yesterday and that was the first time I felt a tickle of spinal pain return.

The mindset here is to ultimately have as little pain medication as needed to keep the spinal pain suppressed. Whether that means totally off of every prescription drug or not, I don’t know yet.

I am going to see a specialist this fall but i want to taper further on my own first. It’s just my way. I have everything I need at home.

This morning I decided to use suboxone to assist with the taper. I only took 1mg, not sure if I would cause precipitated withdrawal. And to my surprise, the 1mg almost knocked me out! Super drowsy within 20 minutes and right now I think I actually have a slight buzz. That wasn’t the goal but it is there.

We will see how this goes, but I do NOT plan to stay on subs. I view this as a middle step in a taper. I will probably go back to oxy in 5 days or so, just enough to keep pain in check, hopefully at a lower dose. It’ll be my chance to learn whether the fact that suboxone tickles your receptors less actually helps with a taper (or Not).

Once I am at the minimum I need to manage the pain, I will call the specialist and set up an appointment. Rightly or wrongly, I suspect the care may be better if I come in with a habit consistent with pain relief, not a habit consistent with a mega abuser.

I may post in another month or so.

Thanks again

 

[Macadamia]

Thanks all for the replies

Quick update - over the last month I have tapered from 500mg down to around 150mg oxy equivalent per day. I actually did 125mg yesterday and that was the first time I felt a tickle of spinal pain return.

The mindset here is to ultimately have as little pain medication as needed to keep the spinal pain suppressed. Whether that means totally off of every prescription drug or not, I don’t know yet.

I am going to see a specialist this fall but i want to taper further on my own first. It’s just my way. I have everything I need at home.

This morning I decided to use suboxone to assist with the taper. I only took 1mg, not sure if I would cause precipitated withdrawal. And to my surprise, the 1mg almost knocked me out! Super drowsy within 20 minutes and right now I think I actually have a slight buzz. That wasn’t the goal but it is there.

We will see how this goes, but I do NOT plan to stay on subs. I view this as a middle step in a taper. I will probably go back to oxy in 5 days or so, just enough to keep pain in check, hopefully at a lower dose. It’ll be my chance to learn whether the fact that suboxone tickles your receptors less actually helps with a taper (or Not).

Once I am at the minimum I need to manage the pain, I will call the specialist and set up an appointment. Rightly or wrongly, I suspect the care may be better if I come in with a habit consistent with pain relief, not a habit consistent with a mega abuser.

I may post in another month or so.

Thanks again

I know this is 5 months later but I’m posting this in case someone else decides to follow your plan.

you should look up“precipitated withdrawals” this is when you take suboxone while opiates are still in your system, you instantly trigger withdrawals and it’s hell cuz it hits u so hard and fast, cuz the suboxone is ripping the opiates out of your system. In rehab clinics, they wait 72hr after you feel your first withdrawal symptom to start suboxone.

They do this to ensure opiates are out of your system completely, because if any are left you’ll trigger precipitated withdrawals, which are worse than normal withdrawl.

Also, once you start taking suboxone, to kick the suboxone off your receptors and Start taking opiates again, you need around 4x your normal dose to overpower the suboxone ... so this defeats the whole purpose.

PLEASE never take suboxone within 48-72hr of your last opiate dose, even if their fast acting or you take them through as fast acting route of administration.. opiates takes 2-3 days to totally leave your system,

Switching between opiates and suboxone is a bad idea, use Agmatine 1000mg twice a day to lower tolerance, this has been proven through research and it worked wonders for me. You can order it from any fitness or health supplement website or from any supplement store. Get pure agmatine, not products with agmatine as 1 of 30 ingredients.