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Opioids Opioid detox, my approach to suboxone

luigibb94

Greenlighter
Joined
Apr 15, 2021
Messages
3
Swim has had a very bad opioid problem, specially fentanyl, swim used to use so much that when he tried some heroin iv he barely got a buzz and there was so much dope in the shot it would barely pass through the hole in the needle.

Getting clean was a hassle and all rehabs failed, but swim managed to do it at home. If you use fenatyl or iv heroin i would suggest to just smoke heroin a week prior to detox.
When you start to detox the more you last before taking suboxone the better, when I give up and take my first suboxone dose i go heavy (20_40mg) the day after 8_12mg, then the third day 4mg and then I quit it. From then on i don't feel any withdrawal symptoms. If swim takes suboxone for more than 5 -7 days he gets addicted to suboxone.

Another trick which minimizes withdrawal was to take suboxone without barely waiting any time from the last usage. Once the precipitated withrawal starts swim gets high one last time then continues for 2_3 days on suboxone and quits.

Been sober for a year now. Just my 2 cents
 
Joined
Jan 21, 2020
Messages
6,198
Location
Four Mile Creek, St. Clair Township, Ohio
Hey welcome to BL @luigibb94. Please don’t use SWIM here. As for your use of suboxone to get off of opioids, I congratulate you on your year sober.

A lot of people try a short detox with suboxone like you describe and most people aren’t successful and relapse pretty quickly. I am surprised you didn’t feel any withdrawal symptoms. That’s not the norm and you should count yourself lucky. For most people, withdrawal symptoms cannot be avoided no matter what tapering technique they use. There is no magical formula for getting out of withdrawal symptoms for people physically addicted to opioids. Tapering down seems to lessen the severity of symptoms somewhat, but in no way will someone avoid the inevitable hell of opioid withdrawal. You seem to be very luck to get off of them scot free and even more amazingly, you have stayed clean for a year. That’s incredible.

The only reason I am saying this is that even if people follow your method to quit opioids, the likelihood of them being successful is extremely low, unfortunately. By no means am I dismissing your success or minimizing your experience, but I guarantee most people will not have the same luck as you did. There is no magic bullet to beat opioids, and certainly none that will be painless and free from the lasting hell of opioid withdrawal.

I have been clean from opioids for close to a decade now. I stayed clean even after enduring the hell of methadone withdrawals that lasted for over a year. What kept me clean was a hatred for all opioids, because what they took from me and the trap they put me in.

Thanks for sharing your success here. People need to know that it is possible to get and stay clean from opioids, and your example of your success is helps give people hope that they can beat opioid addiction too.

What type of support network did you have to help with your success in all this @luigibb94?

🧙‍♂️
 

Elchicodeoro

Greenlighter
Joined
Feb 13, 2020
Messages
12
Hey welcome to BL @luigibb94. Please don’t use SWIM here. As for your use of suboxone to get off of opioids, I congratulate you on your year sober.

A lot of people try a short detox with suboxone like you describe and most people aren’t successful and relapse pretty quickly. I am surprised you didn’t feel any withdrawal symptoms. That’s not the norm and you should count yourself lucky. For most people, withdrawal symptoms cannot be avoided no matter what tapering technique they use. There is no magical formula for getting out of withdrawal symptoms for people physically addicted to opioids. Tapering down seems to lessen the severity of symptoms somewhat, but in no way will someone avoid the inevitable hell of opioid withdrawal. You seem to be very luck to get off of them scot free and even more amazingly, you have stayed clean for a year. That’s incredible.

The only reason I am saying this is that even if people follow your method to quit opioids, the likelihood of them being successful is extremely low, unfortunately. By no means am I dismissing your success or minimizing your experience, but I guarantee most people will not have the same luck as you did. There is no magic bullet to beat opioids, and certainly none that will be painless and free from the lasting hell of opioid withdrawal.

I have been clean from opioids for close to a decade now. I stayed clean even after enduring the hell of methadone withdrawals that lasted for over a year. What kept me clean was a hatred for all opioids, because what they took from me and the trap they put me in.

Thanks for sharing your success here. People need to know that it is possible to get and stay clean from opioids, and your example of your success is helps give people hope that they can beat opioid addiction too.

What type of support network did you have to help with your success in all this @luigibb94?

🧙‍♂️
I’m attempting to kick pressed M30s been using them for almost 2 years pretty steady. Huge tolerance. I have all the necessary things to help ease my withdrawal, but how long should I wait before I take suboxone? I really really really want to avoid precipitated withdrawal. I have gaba, soma, and hydroxizine as well. Any feedback would be welcomed.
 
Joined
Jan 21, 2020
Messages
6,198
Location
Four Mile Creek, St. Clair Township, Ohio
I’m attempting to kick pressed M30s been using them for almost 2 years pretty steady. Huge tolerance. I have all the necessary things to help ease my withdrawal, but how long should I wait before I take suboxone? I really really really want to avoid precipitated withdrawal. I have gaba, soma, and hydroxizine as well. Any feedback would be welcomed.
It’s very tricky to induce buprenorphine for fentanyl addiction, because fentanyl has one of the highest affinity to opioid receptors that are commonly used in medicine and abuse. Fentanyl is also a very short acting opioid with high efficacy.

Everyday use of fentanyl seems to stick around on those receptors even though it is one of the shortest acting opioid that people abuse. Although fentanyl has a rapid onset and short duration of action, it is lipophilic, resulting in distribution to the peripheral tissues in a manner that is not dose dependent. Consequently, continuous and prolonged use of fentanyl can result in increased volume of distribution systemically with slow dissipation overall.

Buprenorphine has a hard time displacing fentanyl when it’s abused in high doses used daily for weeks or months. Normal induction of buprenorphine will likely cause people to have severe precipitated withdrawals even after days of abstinence of the drug. You could be in severe enough withdrawals after only a few hours of your last use of fentanyl to think that it’s safe to induce buprenorphine by having very high COWS score. Then, only to suffer dangerous precipitated withdrawals. This is what makes it very tricky to induce buprenorphine. Unlike other opioids, a COWS test is a good indication of whether or not it is safe to use bupe. With fentanyl (especially heavy fentanyl use, the COWS test won’t work!

That’s why lot of detox clinics are now waiting at least 72 (sometimes longer) to induce buprenorphine, because precipitated withdrawals for fentanyl can happen days after patients stop use.

Look into the Bernese method of buprenorphine induction for fentanyl.

🧙‍♂️
 
Last edited:
Joined
Jan 21, 2020
Messages
6,198
Location
Four Mile Creek, St. Clair Township, Ohio
Thank you very much. I can’t tell you how much I appreciate it. I will look into the Bernese method. Also, would subutex be an option???
Subutex is just like suboxone, but without naloxone. The naloxone in suboxone is only put in these types of drugs as a marketing ploy to dissuade folks from injecting them, or somehow using them inappropriately. Lol!

🧙‍♂️
 
Joined
Jan 21, 2020
Messages
6,198
Location
Four Mile Creek, St. Clair Township, Ohio
Though it's still tricky so shoot some Subutex, it disolves very badly...
Shooting suboxone or subutex films is dangerous because of the emulsifiers they put into it, which is basically artificial pig fat. I personally wouldn’t want to shoot all of those emulsifier (of any kind) in my veins. Even with a wheel filter it’s tough to get all of that gumminess out of the buprenorphine strips. I know some people do it anyway, but that doesn’t make it safe by any sense of the imagination. The pill forms of subs are not any easier to prepare to shoot either for that matter. Plugging is the way to go if someone doesn’t what to take these drugs as recommended ime.

🧙‍♂️
 

MydriHaze

Bluelighter
Joined
Mar 18, 2016
Messages
3,937
Location
Over the hill..
I used to snore it, makes the job two, but the biodisponibility is like at 30% i think, by plug or sublingual it might be near 100% idk

I tried one time to shoot it, this shit looked liked sperm in a spoon, i overcame my interrogations and try to shoot it, found the vein, but the needle couldn't push, i tried to push harder: nothing, i retried it 3 times thinking i was off the vein but no, it's just too weird...
 

Ricman78

Greenlighter
Joined
May 26, 2021
Messages
1
Hey welcome to BL @luigibb94. Please don’t use SWIM here. As for your use of suboxone to get off of opioids, I congratulate you on your year sober.

A lot of people try a short detox with suboxone like you describe and most people aren’t successful and relapse pretty quickly. I am surprised you didn’t feel any withdrawal symptoms. That’s not the norm and you should count yourself lucky. For most people, withdrawal symptoms cannot be avoided no matter what tapering technique they use. There is no magical formula for getting out of withdrawal symptoms for people physically addicted to opioids. Tapering down seems to lessen the severity of symptoms somewhat, but in no way will someone avoid the inevitable hell of opioid withdrawal. You seem to be very luck to get off of them scot free and even more amazingly, you have stayed clean for a year. That’s incredible.

The only reason I am saying this is that even if people follow your method to quit opioids, the likelihood of them being successful is extremely low, unfortunately. By no means am I dismissing your success or minimizing your experience, but I guarantee most people will not have the same luck as you did. There is no magic bullet to beat opioids, and certainly none that will be painless and free from the lasting hell of opioid withdrawal.

I have been clean from opioids for close to a decade now. I stayed clean even after enduring the hell of methadone withdrawals that lasted for over a year. What kept me clean was a hatred for all opioids, because what they took from me and the trap they put me in.

Thanks for sharing your success here. People need to know that it is possible to get and stay clean from opioids, and your example of your success is helps give people hope that they can beat opioid addiction too.

What type of support network did you have to help with your success in all this @luigibb94?

🧙‍♂️
I’ve been reading this forum for years, it amazes me the wealth of knowledge you have. If you don’t mind me asking a quick question on the least painful way of going from 2g H habit a day to subs. I have done this a handful of times in the past with varying degrees of success. The whole 24 hour wait always drives me insane (more so mentally I suspect). Any advice on how to just get through the wait as painless as possible. Sounds like somewhat of a easy thing to figure out on my own, but this is the part I have the most trouble with. Thanks in advance for any advice you or any other readers may have.
Cheers!
 
Joined
Jan 21, 2020
Messages
6,198
Location
Four Mile Creek, St. Clair Township, Ohio
I’ve been reading this forum for years, it amazes me the wealth of knowledge you have. If you don’t mind me asking a quick question on the least painful way of going from 2g H habit a day to subs. I have done this a handful of times in the past with varying degrees of success. The whole 24 hour wait always drives me insane (more so mentally I suspect). Any advice on how to just get through the wait as painless as possible. Sounds like somewhat of a easy thing to figure out on my own, but this is the part I have the most trouble with. Thanks in advance for any advice you or any other readers may have.
Cheers!
I’d take a look into the Bernese Method of buprenorphine using a full agonist like heroin. I haven’t done it personally because I’ve been off opioids for around 8 years now, but I have heard of many success stories here and elsewhere. What it basically entails is, continuing to use heroin (or whatever) and slowly micro-dosing bupe at specific doses titrating up.


Please look up specific about this Bernese Method for more details.

🧙‍♂️
 

Boomoon

Greenlighter
Joined
May 26, 2021
Messages
3
I’ve been reading this forum for years, it amazes me the wealth of knowledge you have. If you don’t mind me asking a quick question on the least painful way of going from 2g H habit a day to subs. I have done this a handful of times in the past with varying degrees of success. The whole 24 hour wait always drives me insane (more so mentally I suspect). Any advice on how to just get through the wait as painless as possible. Sounds like somewhat of a easy thing to figure out on my own, but this is the part I have the most trouble with. Thanks in advance for any advice you or any other readers may have.
Cheers!
It's pretty simple really. You have to go 6 to 8 hours into the heavy part of withdrawal and at that point you take your first Suboxone. If that doesn't work wait 2 hours and take another. It'll be a rough opening night but by the next day you'll be good. Some advice here would be to not keep yourself on very low doses of it because you can still use. There's no point in getting on it if you still plan on using other than to catch yourself when you think you're going to get sick.
 

tweakette

Bluelighter
Joined
Dec 10, 2008
Messages
55
Th
It's pretty simple really. You have to go 6 to 8 hours into the heavy part of withdrawal and at that point you take your first Suboxone. If that doesn't work wait 2 hours and take another. It'll be a rough opening night but by the next day you'll be good. Some advice here would be to not keep yourself on very low doses of it because you can still use. There's no point in getting on it if you still plan on using other than to catch yourself when you think you're going to get sick.
Thats not what the Bernese method means. It doesn’t meant keep you on a low dose so you can still use. It means you slowly introduce low doses of subs and go up in dose until you no longer take opioids. 🙄 Look it up before you attack.
 

Nerpa

Greenlighter
Joined
Jun 26, 2021
Messages
1
It’s very tricky to induce buprenorphine for fentanyl addiction, because fentanyl has one of the highest affinity to opioid receptors that are commonly used in medicine and abuse. Fentanyl is also a very short acting opioid with high efficacy.

Everyday use of fentanyl seems to stick around on those receptors even though it is one of the shortest acting opioid that people abuse. Although fentanyl has a rapid onset and short duration of action, it is lipophilic, resulting in distribution to the peripheral tissues in a manner that is not dose dependent. Consequently, continuous and prolonged use of fentanyl can result in increased volume of distribution systemically with slow dissipation overall.

Buprenorphine has a hard time displacing fentanyl when it’s abused in high doses used daily for weeks or months. Normal induction of buprenorphine will likely cause people to have severe precipitated withdrawals even after days of abstinence of the drug. You could be in severe enough withdrawals after only a few hours of your last use of fentanyl to think that it’s safe to induce buprenorphine by having very high COWS score. Then, only to suffer dangerous precipitated withdrawals. This is what makes it very tricky to induce buprenorphine. Unlike other opioids, a COWS test is a good indication of whether or not it is safe to use bupe. With fentanyl (especially heavy fentanyl use, the COWS test won’t work!

That’s why lot of detox clinics are now waiting at least 72 (sometimes longer) to induce buprenorphine, because precipitated withdrawals for fentanyl can happen days after patients stop use.

Look into the Bernese method of buprenorphine induction for fentanyl.

🧙‍♂️

Hello Wizard of the Creek


This is my first post. My 27 y/o daughter is addicted to meth and fentanyl. The opiate addiction began about 6 year ago with IV heroin and moved to fentanyl and its analogues within 2 years. She has been on fentanyl for 4 years and her ROA is smoking with a nectar collector. My best guess is she is using 3g every 5-6 days.

She has tried OAT (opiate agonist therapy) with BUP/NLX and methadone. The two induction attempts of BUP/NLX led to precipitated withdrawals. Her three attempts with methadone ended with relapse. She learned about the "Bernese Method" or microdosing at the beginning of this year and was willing to try it. We looked at several different dosing schedules and chose to err on the side of caution and decided on a 14 day microdose induction with the goal of being between 12 and 16mg of BUP/NLX before discontinuation of the fent. (This dosing schedule was adapted from the London RAAM Clinic in Ontario Canada).

As you stated, fentanyl is lipophilic with slow dissipation caused by continuous and prolonged high dose use. My daughter had anorexia for several years and struggled to maintain a weight of 105 - 110 pounds. But, in the last 18 months she has gained over 100 pounds. The logical assumption is that this even hinders clearance of fentanyl. How long it will stay in her system is unknowable. In a recent study by Huhn et al, a participant was still positive for fentanyl 26 days after his last use.

In a case like my daughter’s, the preferred first step would be to switch to a short acting full agonist opiate such as slow release oral morphine to "wash out" or clear the illicit fent from her system. But in the US, doctors with a waiver to prescribe buprenorphine for OUD are not allow to prescribe additional opiates as a bridge to induction to avoid precipitated withdrawls. So she started the microdosing of BUP/NLX while continuing her DOC, that being her only option.

My daughter tried to discontinue the fentanyl three time over the last 2 1/2 months after titrating up to 12 to 14mg BUP/NLX. But when she would discontinue the fentanyl, she would still get moderate to severe withdrawal symptoms within 90 minutes of taking the BUP. Even though she could still take an additional 8mg on those days the fear of inducing precipitated withdrawals was too great and she refused to take anymore BUP.

So we are grabbing at straws now. The current treatment plan is to go on methadone (because there is no other choice for a bridge drug), stay on the lowest dose possible for 3 -4 weeks and hope that is long enough to clear the fentanyl from her body. She will then ask the clinic for a taper off the methadone and when she is below 40mg, she will start microdosing the BUP/NLX.

But... when she has a random UA and tests positive for BUP she will be kicked out of the program. By law the clinic is required to do a detox but the duration is their choice. We just hope the detox is long enough for her to complete the induction.

And if that's not enough barriers to treatment, she cannot start the methadone yet because she is still positive for BUP nine days after her last use. She will try again to be admitted on Monday.

FYI, her psychiastrist supports her using a microdosing prodocal for induction but does not know anything about it.

We are looking for any suggestions. If the methadone plan doesn't pan out - there are a few hospitals that are using microdosing (out of state) but I have not found any that are actively using a bridge with a short acting opiate outside of clinical studies.
 

Lobita

Bluelighter
Joined
Apr 16, 2021
Messages
32
Location
West Milford, NJ
Hello Wizard of the Creek


This is my first post. My 27 y/o daughter is addicted to meth and fentanyl. The opiate addiction began about 6 year ago with IV heroin and moved to fentanyl and its analogues within 2 years. She has been on fentanyl for 4 years and her ROA is smoking with a nectar collector. My best guess is she is using 3g every 5-6 days.

She has tried OAT (opiate agonist therapy) with BUP/NLX and methadone. The two induction attempts of BUP/NLX led to precipitated withdrawals. Her three attempts with methadone ended with relapse. She learned about the "Bernese Method" or microdosing at the beginning of this year and was willing to try it. We looked at several different dosing schedules and chose to err on the side of caution and decided on a 14 day microdose induction with the goal of being between 12 and 16mg of BUP/NLX before discontinuation of the fent. (This dosing schedule was adapted from the London RAAM Clinic in Ontario Canada).

As you stated, fentanyl is lipophilic with slow dissipation caused by continuous and prolonged high dose use. My daughter had anorexia for several years and struggled to maintain a weight of 105 - 110 pounds. But, in the last 18 months she has gained over 100 pounds. The logical assumption is that this even hinders clearance of fentanyl. How long it will stay in her system is unknowable. In a recent study by Huhn et al, a participant was still positive for fentanyl 26 days after his last use.

In a case like my daughter’s, the preferred first step would be to switch to a short acting full agonist opiate such as slow release oral morphine to "wash out" or clear the illicit fent from her system. But in the US, doctors with a waiver to prescribe buprenorphine for OUD are not allow to prescribe additional opiates as a bridge to induction to avoid precipitated withdrawls. So she started the microdosing of BUP/NLX while continuing her DOC, that being her only option.

My daughter tried to discontinue the fentanyl three time over the last 2 1/2 months after titrating up to 12 to 14mg BUP/NLX. But when she would discontinue the fentanyl, she would still get moderate to severe withdrawal symptoms within 90 minutes of taking the BUP. Even though she could still take an additional 8mg on those days the fear of inducing precipitated withdrawals was too great and she refused to take anymore BUP.

So we are grabbing at straws now. The current treatment plan is to go on methadone (because there is no other choice for a bridge drug), stay on the lowest dose possible for 3 -4 weeks and hope that is long enough to clear the fentanyl from her body. She will then ask the clinic for a taper off the methadone and when she is below 40mg, she will start microdosing the BUP/NLX.

But... when she has a random UA and tests positive for BUP she will be kicked out of the program. By law the clinic is required to do a detox but the duration is their choice. We just hope the detox is long enough for her to complete the induction.

And if that's not enough barriers to treatment, she cannot start the methadone yet because she is still positive for BUP nine days after her last use. She will try again to be admitted on Monday.

FYI, her psychiastrist supports her using a microdosing prodocal for induction but does not know anything about it.

We are looking for any suggestions. If the methadone plan doesn't pan out - there are a few hospitals that are using microdosing (out of state) but I have not found any that are actively using a bridge with a short acting opiate outside of clinical studies.
Hi! I’ve been on Methadone for about 5 years... you must have an opiate in your system for them to dose you. Also, one positive urine screen would not get someone kicked out. Several months of positive urine screens with no signs of improvement would get someone detoxed out of the program. At least at every clinic I’ve been at (5 between two states)
 

GetMeOutOfThisCRAP

Bluelighter
Joined
Dec 20, 2017
Messages
1,744
If the withdrawal is horrible beyond words (like for me that is fent or just some unreasonably high dose oxy) it is so strange to me how suboxone works. I will be on suboxone for 2 days alone and then walk off scott free from any withdrawal and just be okay on kratom. I just had to do that again from a terribly unfun relapse run.

I don't think I want to do oxycodone ever again or fent and blah blah analogues. They actually just feel really damn awful now lol. I used to just relapse for a fun nice weekend or something. Now I just feel like crap. The high makes me feel in the negative zone as before it used to push me above anything in the natural realm if that makes sense. Maybe I've swallowed enough of these things to kill a whale lol. Just interesting to me how suboxone would mitigate such a bad withdrawal so quickly for my brain. Otherwise, with kratom alone I would withdraw from 14 days straight more or less of terrible depression and you know the deal.
 

Lobita

Bluelighter
Joined
Apr 16, 2021
Messages
32
Location
West Milford, NJ
Hello Wizard of the Creek


This is my first post. My 27 y/o daughter is addicted to meth and fentanyl. The opiate addiction began about 6 year ago with IV heroin and moved to fentanyl and its analogues within 2 years. She has been on fentanyl for 4 years and her ROA is smoking with a nectar collector. My best guess is she is using 3g every 5-6 days.

She has tried OAT (opiate agonist therapy) with BUP/NLX and methadone. The two induction attempts of BUP/NLX led to precipitated withdrawals. Her three attempts with methadone ended with relapse. She learned about the "Bernese Method" or microdosing at the beginning of this year and was willing to try it. We looked at several different dosing schedules and chose to err on the side of caution and decided on a 14 day microdose induction with the goal of being between 12 and 16mg of BUP/NLX before discontinuation of the fent. (This dosing schedule was adapted from the London RAAM Clinic in Ontario Canada).

As you stated, fentanyl is lipophilic with slow dissipation caused by continuous and prolonged high dose use. My daughter had anorexia for several years and struggled to maintain a weight of 105 - 110 pounds. But, in the last 18 months she has gained over 100 pounds. The logical assumption is that this even hinders clearance of fentanyl. How long it will stay in her system is unknowable. In a recent study by Huhn et al, a participant was still positive for fentanyl 26 days after his last use.

In a case like my daughter’s, the preferred first step would be to switch to a short acting full agonist opiate such as slow release oral morphine to "wash out" or clear the illicit fent from her system. But in the US, doctors with a waiver to prescribe buprenorphine for OUD are not allow to prescribe additional opiates as a bridge to induction to avoid precipitated withdrawls. So she started the microdosing of BUP/NLX while continuing her DOC, that being her only option.

My daughter tried to discontinue the fentanyl three time over the last 2 1/2 months after titrating up to 12 to 14mg BUP/NLX. But when she would discontinue the fentanyl, she would still get moderate to severe withdrawal symptoms within 90 minutes of taking the BUP. Even though she could still take an additional 8mg on those days the fear of inducing precipitated withdrawals was too great and she refused to take anymore BUP.

So we are grabbing at straws now. The current treatment plan is to go on methadone (because there is no other choice for a bridge drug), stay on the lowest dose possible for 3 -4 weeks and hope that is long enough to clear the fentanyl from her body. She will then ask the clinic for a taper off the methadone and when she is below 40mg, she will start microdosing the BUP/NLX.

But... when she has a random UA and tests positive for BUP she will be kicked out of the program. By law the clinic is required to do a detox but the duration is their choice. We just hope the detox is long enough for her to complete the induction.

And if that's not enough barriers to treatment, she cannot start the methadone yet because she is still positive for BUP nine days after her last use. She will try again to be admitted on Monday.

FYI, her psychiastrist supports her using a microdosing prodocal for induction but does not know anything about it.

We are looking for any suggestions. If the methadone plan doesn't pan out - there are a few hospitals that are using microdosing (out of state) but I have not found any that are actively using a bridge with a short acting opiate outside of clinical studies.
You can also try Kratom to use as a bridge
 
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