In response to a post on another website regarding Suboxone tapering I found there is a large amount of misinformation out there. I wrote a response to help clear out the wrong info and educate on the correct info about Suboxone and the process of getting off Suboxone. Before I go into any explanation I want to refer people to a link I found very helpful. This link is a 15 page article (from 2014) written by a DOCTOR. He is a doctor from South Florida who specifically focuses on Suboxone's effects and how he was able to successfully taper people off suboxone. It breaks down all the specifics of what part of your body is effected by the drug along with what helps with tapering and how to successfully come off it. This is based on his experience with patients and his own research.
Here is the link:
Detoxing Suboxone: Fear Caused by Lack of Knowledge
Here are some quick facts to know:
These are based on personal experience (I took Suboxone for 2 years starting at 8mg a day), lots of research and speaking with doctors.
* During days 2-4 of a taper prepare to only have about 6-8 FUNCTIONAL hours in which you can work, run errands, etc. Plan to have these days land on a weekend. You will need about 14 hours to rest and take it easy until your system adjusts to the lower dose. Use this time to do LIGHT exercise and anything important to relieve stress. *
Starting by day 5-6 the withdrawals will alleviate slightly more until they are completely gone by day 10. AFTER day 10 there MIGHT BE be depression, insomnia, etc. This is NOT because of the drug. This is related to psychological symptoms like not having a good habit of going to sleep and waking up at the same time. Not having things to do during the day to fill up your life. All of these are easily fixed by out-patient programs, 12-step meets or any other recovery based help.
REMEMBER these symptoms only last 7-10 days. NOT FOREVER! In order to make this as painless as possible WAIT until you have tapered down to between 1mg -.25 mg a day. Additionally put aside 10 days to withdraw. Take off from work, school, etc. If you do not want to tell anyone you are coming off Suboxone than tell people you have the flu. The symptoms and time frame are almost exactly the same as having the flu. Have some easy things planned to do during these days to stay occupied. Like some new movies and video games prepared, walk around the neighborhood, EASY errands to run, etc.
Link for ALL the over-the-counter medication (with dosage and time frame) to take in order to alleviate withdrawal symptoms:
Link for detailed MEDICAL instructions on what Suboxone is and how to come off it:
Link to OFFICIAL Suboxone website:
Please post any additional links and information. If you post about personal experience please be as specific as possible about body weight, age, suboxone dose, time frame, additional medication, relapses, etc. I would like to make this a reliable and informative thread for people to come to in the future.
Here is the link:
Detoxing Suboxone: Fear Caused by Lack of Knowledge
Here are some quick facts to know:
These are based on personal experience (I took Suboxone for 2 years starting at 8mg a day), lots of research and speaking with doctors.
- Suboxone has a HALF-LIFE of 24-60 hours. This is based on your metabolism, weight, etc. For simplicity let's just work with 24 hours. This means if you take 1 mg of suboxone today then 25 hours from now you will have .5 mg left in your body. If you then take ANOTHER 1 mg you will have 1.5 mg in your body (the 1 mg you took today plus the .5 mg left over from yesterday). By understanding this simple math you can see how the drug STACKS in your body. This is why it is IMPERATIVE that you take the SAME AMOUNT everyday at the same time!
- There are now four (4) types of Suboxone strips: 12mg/3mg, 8mg/2mg, 4mg/1mg and 2mg/.5mg. The larger number is the amount of Buprenorphine while the smaller number is the amount of Naloxone. For example: a 2mg/.5mg Suboxone strip has 2mg of Buprenorphine and .5mg of Naloxone in it. When you are reading (or writing) about taking strips of Suboxone keep in mind the strength must be written. If you read/write a post that doesn't mention the strength then the information in it can easily be MISunderstood. When someone says they have been taking 2 strips a day and have trouble tapering it must be written if those 2 strips were 8mg, 2mg, etc. Otherwise the information can easily be misinterpreted.
- Suboxone has two (2) chemicals in it: Buprenorphine AND Naloxone. Buprenorphine is the only chemical that binds to the brains opiate receptors and calms withdrawal symptoms. Buprenorphine is the chemical that has a 24-60 hours half-life and is doing all the work. Naloxone is only added to prevent abuse. Naloxone ONLY is effective if it is injected into a vein. When taken sublingually (dissolved under the tongue) it is broken down BEFORE reaching the brain. Meaning it has absolutely NO EFFECT. No side effects at all, it is like it was never there. It only exists and activates when injected to prevent people from abusing suboxone.
- Buprenorphine takes between 30-90 minutes to fully absorb and activate in the brain. This means that once you are in withdrawal you must wait up to 90 minutes AFTER taking your dose to tell if it is strong enough. If you still are withdrawing after 90 minutes you can take more. Repeat this process (waiting 90 minutes between doses) until withdrawals go away. Whatever the total dose was is the number you should take EVERY DAY. DO NOT TAKE MORE ON ANY DAY! Remember that Buprenorphine will STACK in your body. When you re-dose tomorrow you will still have HALF of yesterdays dose left in your body.
- Buprenorphine is MUCH STRONGER than other opiates. There is a large confusion about what precipitated withdrawal is. Buprenorphine has a stronger attachment to opioid receptors then other opioids. As a result, if you currently have ANOTHER opioid in your brain (such as oxycodone or heroin/morphine) the Buprenorphine will wrap around it. This means the Buprenorphine will NOT be able to stimulate the receptor (the other opioid is stuck in-between the receptor and the Buprenorphine) additionally the Buprenorphine will now block any additional opioids from coming in contact with the receptor. The result is being put into a state or withdrawal that can not be relieved with either Buprenorphine OR other opioids. Which leads to the next fact:
- You must wait AT LEAST 16 hours after your last opioid dose BEFORE taking Suboxone. The longer the better. 16 hours is a general rule of thumb for most opioid (morphine/heroin is a little less, oxy/hydrocodone a little more, methadone A LOT more [36-72 hours]). If you're not sure if it's been enough time go AT LEAST 16 hours and wait until you have reached withdrawal symptoms that are too intense to handle. That is the time in which enough of your opioid receptors are now free and exposed, ready to be stimulated by the Buprenorphine. Otherwise you risk going into precipitated withdrawal.
- What is "Precipitated Withdrawal"? This is the term for what can happen if one takes Buprenorphine BEFORE the majority of other opiates have left the body. It will cause you to go into immediate withdraw but will also block the receptors preventing any absorption of opiates in order to alleviate the symptoms. Thus causing a forced withdraw upon which there is no escape except waiting it out. This is why it is IMPERATIVE to wait at least 16 hours from last opiate dose BEFORE taking Suboxone. The best analogy I can think of to explain this effect is to imagine Buprenorphine as molten metal. It gets poured on the brain receptor in order to stimulate it then hardens in place. IF there is already another opiate on that receptor then the buprenorphine will wrap AROUND that opiate and "harden". Once the opiate has dissolved there will now be a void between the brain receptor and the "hardened" buprenorphine. Thus preventing the buprenorphine from stimulating the receptor AND blocking any outside opiates from reaching the receptor. In this scenario all one can do is wait until the buprenorphine has broken down to expose enough receptors that can be stimulated by opiates. However, due to the long half life of buprenorphine, by the time this happens one would ALREADY of finished going through the standard 72 hours opiate withdrawal.
- Taking an opioid sooner than 24 hours after your last dose of Buprenorphine will DO NOTHING! If you are so inclined to take an opiate while taking suboxone it will have NO effect if it is taken within 24 hours of your last Suboxone dose. This time frame can be as low as 12 hours or as high as 72 hours. It depends on the Buprenorphine dose and how long Suboxone has been taken daily. *Refer to the first point about Suboxone half-life and stacking. You WILL NOT go into withdrawal if you attempt this. Best case scenario the opiate will be effective, worst case scenario it will do nothing and you will feel exactly the same (and wasted an opiate). *Also keep in mind that IF you do feel an effect from the opiate you now MUST WAIT another 16 hours before taking Suboxone again to prevent precipitated withdrawal.
- When Tapering Off: FOR EXAMPLE: IF you are CURRENTLY taking 8mg regularly reduce your dosage by 1mg for a total of 7mg per day (a 1mg drop). Then (this is important!) STAY AT THAT DOSE for 5-10 days. On days 2-4 you will experience very light withdrawal as you body adapts. After day 5 you will feel the same as before you started. After 5-10 days you can decrease again and continue to do this until you are regularly taking 1mg per day or less. At 1mg per day or less you are in the range to be able to stop completely.
- The numbers for how much to taper based on what MG you are currently taking is this:
- 6mg or more: can go down 1mg every 5-10 days
- 6mg - 2mg: can go down .5mg every 5-10 days
- 2mg or less: can go down .25 mg every 5-10 days
- The numbers for how much to taper based on what MG you are currently taking is this:
* During days 2-4 of a taper prepare to only have about 6-8 FUNCTIONAL hours in which you can work, run errands, etc. Plan to have these days land on a weekend. You will need about 14 hours to rest and take it easy until your system adjusts to the lower dose. Use this time to do LIGHT exercise and anything important to relieve stress. *
- It takes 7-10 days to fully recover after you stop taking Suboxone. After you quit (preferably once taking between 1mg - .25mg a day) you will feel perfectly fine for the first 48 hours (2 days).
- Days 1-2 will have virtually NO withdrawal symptoms.
- Days 3-5 will be the roughest. Prepare for acute: insomnia, muscle cramps, low energy and other flu-like symptoms. They will NOT be as intense as the first 72 hours of withdrawal from a regular opiate. They will be softer but last longer. It will come in waves of an hour or so of symptoms followed by an hour or 2 of relief.
- Days 6-10 will be the up-swing. With each passing day the withdrawal symptoms will reduce.
Starting by day 5-6 the withdrawals will alleviate slightly more until they are completely gone by day 10. AFTER day 10 there MIGHT BE be depression, insomnia, etc. This is NOT because of the drug. This is related to psychological symptoms like not having a good habit of going to sleep and waking up at the same time. Not having things to do during the day to fill up your life. All of these are easily fixed by out-patient programs, 12-step meets or any other recovery based help.
- To assist with Suboxone withdrawal:
- Melatonin (at a dose of 5mg or less) will assist with sleep and insomnia. Buy a bottle of 1mg Melatonin to test which dose is right for you. After taking your first dose WAIT 20 minutes with your eyes closed, if it doesn't put you to sleep take 1 mg more and wait 20 min. Repeat until you fall asleep. Now take that same TOTAL dose the next night.
- Ibuprofen & Tylenol [200 - 600mg of Ibuprofen] and [500-1000mg of Tylenol] taken every 6 hours (and before bed) will greatly help with muscle cramps.
- Imodium (preferably in liquid form) will help with any stomach issues.
REMEMBER these symptoms only last 7-10 days. NOT FOREVER! In order to make this as painless as possible WAIT until you have tapered down to between 1mg -.25 mg a day. Additionally put aside 10 days to withdraw. Take off from work, school, etc. If you do not want to tell anyone you are coming off Suboxone than tell people you have the flu. The symptoms and time frame are almost exactly the same as having the flu. Have some easy things planned to do during these days to stay occupied. Like some new movies and video games prepared, walk around the neighborhood, EASY errands to run, etc.
VERY HELPFUL SUBOXONE LINKS:
Link for ALL the over-the-counter medication (with dosage and time frame) to take in order to alleviate withdrawal symptoms:
Link for detailed MEDICAL instructions on what Suboxone is and how to come off it:
Link to OFFICIAL Suboxone website:
Please post any additional links and information. If you post about personal experience please be as specific as possible about body weight, age, suboxone dose, time frame, additional medication, relapses, etc. I would like to make this a reliable and informative thread for people to come to in the future.
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