Taper Smart
During my first appointment with the local addiction Dr, he say: "When we're done, you'll be able to walk by a table piled with blues (perc 30s) without giving it a second thought (that first day I remember my first thought was that I wanted to steal that table in order to sell the majority and keep a marvelous head stash for myself). He is a good Dr. and will only do a minimum six month buprenorphine maintenance cycle, which is generally considered the shortest period for comprehensive treatment leading to a and long-lasting abstinence. A year is more practical term of treatment that really minimizes, compared to six months, the chance of relapse. The point of long term suboxone use is to modify your lifestyle and recover a sober brain chemistry - to get a good distance between your period of abuse and being clean. This is the most important part of anyones recovery: think of your morning suboxone dose as perfunctory and routine act like brushing you teeth every morning. While the idea of short suboxone detoxes (3days to anything less than 6months) or short-acting opiate tapers seem ideal and inexpensive, the chance of relapsing in such cases must be well over 70% Picking up the pieces from your life of substance abuse while, at the same time rebuilding it takes more than a few days. When you were using, I assume, bridges were burned, family and loved ones have been hurt. Repairing relationships with family, friends, and maybe more importantly regaining respect for yourself, takes at least 6 months.
A year goes by fast. For me at least, there was something about getting below 1mg suboxone: the drops from 1mg were considerably harder- my symptom of choice is restless leg (unbearable); I'd take more sub at night now and then, mess up my dose schedule and piss off my Dr- and my taper slowed considerably. From 1mg, I tapered down in 0.25mg intervals very slowly over around 3 months. Each drop took me about 10-14 days to get used to before stabilizing. Once I was at 0.5mg and stable my Dr gave me two 2mg strips, a hug and some well-wishes. Bittersweet. Lo and behold, I can now image walking past a massive pile of perc 30s without craving or compulsive thoughts. Anyway, I stayed on 0.5 for 4 more days and then cut up my last 2mg strip into 8 pieces and prepared to jump off in a one and a week. I didn't like that drop too much; in fact, I managed it poorly and ended up taking my last dose yesterday morning, only six days after my drop to 0.25mg.
Btw, a few times towards the end of my taper, I'd leave myself with nothing the day of my appointment: both times mild withdrawal symptoms began late morning. And after the drive to the Drs, the waiting room, and some idle chit chat with doc, I was about ready to raise my voice and floor it to the closest pharmacy dope-sick and sweaty. In my case, going from 2mg to 1mg is ALOT harder than going from 8mg to 7mg - I suppose that's because you're dropping a higher percentage of your overall dose. That makes sense, but I cant emphasize this enough: I think it's smart to slow your taper down substantially at 1 or 2 mg before your jump at 0.25. Everyone posting horror stories, here and elsewhere, about the nightmare of buprenepherine withdrawals didn't taper responsibly (that's my theory at least). Start high at 8mg or 16mg depending on where you're at, stay on track through the higher drops and get down to a low dose relatively fast (2mg-1mg) but then SLOW DOWN. Being on a low dose is better for your body: you're healing and normalizing your brain chemistry at low doses. At less than 2mg, you're below blocking levels, and the naloxone ceases to be effective around 1mg bupe for sure, so be strong.
The point of maintenance is to get yourself together, stabilize your body and emotions and distance yourself from the self destructive behavior that put you in a hole in the first place. A year is a short amount of time when it comes to brain chemistry. Going off suboxone, however, is no joke. Now, at the end of day 2, I feel weak and exhausted from my 4hrs of benzo sleep. Honestly, i'm not looking forward to lying down tonight either. But, so far at least, it's not the "hell" that some people are describing in their posts. On blogger goes so far as to compare suboxone withdrawal to Dante's Inferno. Poignant analogy, but misleading for people tapering responsibly. A proper taper is essential to minimizing withdrawal effects, but don't be foolish, some testing symptoms are inevitable. This is the high-price you pay for the "good times": opiate withdrawal really is terrible, self-inflicted suffering. For me, restless leg is the most tormenting and unbearable withdrawal symptom, but everyone is different and by the end you should know what to expect, especially after the abruptness of the last drop to .25mg. But, "..as was said three thousand years ago, so still it must be said 'the judgments of the Lord are true and righteous altogether'." (Yeah, I just compared buprenorphine withdrawal to the Civil War).
Its now been two night since I jumped. Let me be systematic: Last night sucked dick. I got hit with restless leg BAD. I had to stand, and eventually ended up doing loops in the cemetery behind my house till 4am. This is not what I wanted to be doing that night. Set time aside for your jump and let people you trust know whats going on. Chances are everyone is used to seeing you look like shit anyway; little do they know- and little sympathy too if they've paid the emotional toll of worrying about you while you were using and through your taper- that withdrawal is like swine flue and RLS combined just for good measure. If you're lucky enough to have a willing partner there with you I have to say: sex (and sheer exhaustion) cured my acute RSL last night. It was a very unpleasant night, and many a mundane epiphanies were had. It comes down to mind over matter, might as well utilize relaxation techniques and mindfulness to relax and loosen up in such a tense situation. Did I mention to HAVE SEX IF POSSIBLE. I'm a lucky guy and after all that restless pacing in the cemetery fretting over RLS, I was out like a light 5min post coitus.
Tomorrow is going to be the worst day, I think, but I'm confident that, with a little clonazapam and mirapex, this upcoming week isn't gonna be the horror story it's portrayed as in many online drug forums. It's all about smart tapering.