Opioids weening off (why do you need a special drug)

[take_a_SWIM]

I may have recently developed an opiate problem in the 120 MG oxycodone per day range. I've found i was able to ween off the dosage by taking 10mg less each day. This begs the question - why do all these recovery assistance drugs exist like suboxone and subutex. Why aren't people weened off oxycodone by taking less and less oxycodone. Labs could set it up so dosages are as granular as 1 mg if they wanted to. Each day the person in rehab takes 1 mg less oxycodone until they are taking 0. Is there a reason this wouldn't work? Does something happen at extremely high dosages? Is subutex a big scam so big pharma gets you coming and going with two different drugs?

 

[falsifiedhypothesi]

They use suboxone and methadone because they are very long lasting, also because they block other opiates in their own ways. You can taper with shorter acting opiates like oxycodone but it's more susceptible to the ups and downs of withdrawals if not dosed right, which might cause someone to relapse.

The longer action causes a more consistent state of mind because the drug wears off much more slowly. Also if you are addicted to oxycodone and the way it makes you feel you might be more likely to relapse if you continue to take oxycodone and have it around.

 

[LucidSDreamr]

Addicts don't have the self control to ween themselves off a drug that gives a powerful high if u take alot

 

[uncle_jocko]

I'd say Lucid nailed it ... most people who are addicts (myself included) don't have the discipline to wean off; otherwise, there would be no need for Suboxone. Today, I'm down to 13.75mgs a day of Oxy on a slow taper. I've actually been doing quite well on this taper; but then again, I'm in my 50's, have a new promotion in my career, and since my relapse last March, it never really got that bad. But even still, I have my slips (on average, I seem to have one day per week in which I slip and take a few extra pills). In addition, "take_a_SWIM" - I think you have a great point. Unfortunately, most doctors (my pain management doctor included) don't seem to be well-versed in a solid taper from the current opiate one is taking. In my opinion, this needs to be part of the solution in this opiate crisis. Since I have been given a promotion at my job (and not one person at my job knows of my relapse), I definitely HAVE to do a slow taper, and it's working rather well. But again, I have incentive: I have a solid promotion which requires me to be "clear headed". And even more, I've been to rehab (9 years back), and it was an AWFUL experience. So, without this taper, I know I'll fall into the depths of opiate addiction (been there), I'll lose my promotion, and I'll end up back in that god-awful rehab. Screw that.

My point is, most young opiate addicts probably don't have the discipline to adhere to a strict taper. It's difficult to remain inspired if one's life isn't going in a positive direction and the temptation of that "warm, fuzzy, opiate blanket" is right next to us. I could ramble on about this stuff, as you can probably tell ... I'm quite passionate about the subject. The bummer with Suboxone is that, by most accounts, it's a bitch to taper from. But, some people definitely need it in order to "get on" with life.

 

[Hodor]

I may have recently developed an opiate problem in the 120 MG oxycodone per day range. I've found i was able to ween off the dosage by taking 10mg less each day. This begs the question - why do all these recovery assistance drugs exist like suboxone and subutex. Why aren't people weened off oxycodone by taking less and less oxycodone. Labs could set it up so dosages are as granular as 1 mg if they wanted to. Each day the person in rehab takes 1 mg less oxycodone until they are taking 0. Is there a reason this wouldn't work? Does something happen at extremely high dosages? Is subutex a big scam so big pharma gets you coming and going with two different drugs?

As others have already mentioned, addicts aren't really known for their self control when around their drug of choice. That's pretty much the definition of "addiction".

Opioid maintenance isn't just about reducing opioid tolerance; it's about stabilizing the person, and eliminating their cravings until they are psychologically ready to quit altogether.

Buprenorphine (the active compound in subutex/suboxone) is perhaps the ideal opioid for this purpose mostly because it functions as a partial agonist with a very high binding affinity. That means there is a limit to how high it can get someone (for people with even a modest opioid tolerance, it is very hard to OD on this stuff), and at the same time, it will prevent people from abusing full agonist opioids like morphine or oxycodone because your opioid receptors are already occupied by the buprenorphine, which cannot be easily displaced by other opioids.

 

[Limpet_Chicken]

With ANY drug needing a taper, it's always best to switch to a drug with a long plasma half life IMO, this prevents peaks and troughs, causing withdrawals,whereas with a long acting drug, be it methadone, or a SSRI withdrawal switching to fluoxetine (prozac, which has one HELL of a long half life), this means one can maintain stable levels in plasma. With an addictive drug, if someone wakes up in withdrawal, or starts to withdraw then they are more than likely to think 'fuck, I really need to shoot up now', no?

 

[Keif' Richards]

I'm closing this one shortly. I mean no offense to the OP. I get the curiosity that comes with early encounters with addictive behaviors. It's an interesting question, "Why do people exhibit addictive behavior?" If we knew, we could probably solve the problem. Again, nothing personal. We're a Harm Reduction site and we really have to focus on those who are in need of help.