Bupe So many questions about Suboxone, and my doctor is useless

[pocketsevens]

Hi guys. I finally convinced my psych doctor that my bad habits with my prescribed Oxycodone were part of the reason for my depression. (For example, taking twice as much as I should and running out two weeks early, going through withdrawals for two weeks and starting it all over again.) However it's already been my experience that he doesn't answer my questions about medications. He's super greedy and doesn't allow long enough appointments to answer my questions.

Anyways, he finally prescribed Suboxone, but I'm really annoyed because he didn't even ask how much Oxycodone I was taking. He was just like "We'll start you off at 16mg a day, because that's the standard." So it's two 8mg pills, one in the morning and one at dinner. Well I was taking around 40-65mg of Oxycodone a day, and I think I could do with way less than 16mg, so I've been taking 8 a day.

Anyways, my first question is, how long does it take to become physically addicted to Suboxone? I've only been taking it for three days, and part of me wants to try just stopping. My theory is that my body may already be done withdrawing from the Oxy, and maybe I haven't been on Suboxone long enough to be addicted yet. Is that completely stupid?

My next question is, does anyone have an idea of a schedule for the quickest way to comfortably taper down from Sub? Would it be like going down two milligrams every two days, or does it have to be longer than that? (I found a sample plan for tapering down on this website, but it was over many many weeks and I just don't want to do it that long: http://www.helpmegetoffdrugs.com/taper)

Lastly, I've been super irritable, short-fused, and highly unmotivated since I got on Suboxone. I don't know if this is from the lack of getting high or an actual side effect of Sub, but I reeeeally can't take it. Would a BIGGER or SMALLER dose minimize this side effect? (I.e. maybe I'm irritable because I'm slightly withdrawing?) Would it help to start taking an antidepressant with it? I was thinking an antidepressant that deals with dopamine rather than an SSRI might help since Oxy messes up your dopamine system.

Also, super bad stomach cramps. Once again I don't know if that's a side effect of Sub or I'm withdrawing. Does Suboxone give you stomach cramps? Does it make you even more constipated that Oxy?

Sorry for the jumbled mess of questions.. I swear my brain isn't all there right now. I don't know what I'd do without the support of the people on this website, thanks so much everyone.

 

[undertow13]

Yes, I believe 16mg is way too much. I'm not sure about that being the standard starting dose, although it does appear to be the standard maintenance dose. But that is something that varies between doctors; mine started me at 12mg and then months later bumped me to 16mg, and I've heard of doctors doing inductions where they give the patient 2mg every so often until the patient is comfortable and not feeling any withdrawal. I highly, highly doubt you will need any more than 2mg a day for a 40-65mg/day oxycodone habit.

Even though you've only been on the Suboxone for a few days, you can't just stop without having any withdrawal. The oxycodone might be out of your system, but since you have replaced it with another opiod (buprenorphine), you're going to feel the withdrawal you've been suppressing if you stop taking it abruptly.

As far as tapering, it depends on how you take it. You can use Suboxone either for detox or long-term maintenance. With the detox method, you will start Suboxone and then begin decreasing your dose every day until you are off completely (usually in a week or less). For example, I've heard of people taking 8mg the first day, 6mg the next, 4mg, and so on. That way you can taper off the opiates quickly with minimal to no withdrawal symptoms but without becoming dependent on the Suboxone. I'm not 100% sure on the standard detox protocol though.

For people who take Suboxone every day for a long time (maintenance), the standard taper schedule seems to to be cutting your dose by no more than 25% at a time, usually every 7-10 days, sometimes longer. The reason for this is because withdrawal from bupe can take 3-7+ days to kick in, so if you cut your dose once, you wanna make sure you're going to be comfortable at that dose before making another cut. Again, that only applies if you've been on it long-term.

Another person posted recently about being irritable after starting Suboxone. It could be a side effect, or your body just adjusting to the bupe; it could be that you just want to get high or that you are on too high of a dose. It definitely isn't physical withdrawal from the oxy, 8mg of Suboxone should be more than enough to stop any withdrawal. I would try decreasing your dose. When you're due for your next dose, try taking 2mg and see how you feel. If you need to, you can always take more.

Suboxone can definitely cause stomach cramps and/or constipation. The constipation from Suboxone can be just as bad if not worse than other opiods (depends on the person), but some people don't get constipated from it at all. If the stomach cramps persist even at lower doses, I'd talk to your doctor about it.

 

[pocketsevens]

Thanks, I really appreciate the thorough answer. I only took 2mg today and I'm still feeling tired and irritable. I guess it's just from not having the relief and escape that used to come with getting high... not sure how to stop missing that haha. It's a good thing Suboxone keeps you from being able to get high or else I would have slipped up by now.

 

[AnythingEverything]

The lack of motivation would definitely be from the lack of getting high. I found opiates the best anti depressant. But you will adjust as long as you are getting some kind of therapy.

Although it seems crazy coming from me (im on 32'mg) 16 is way too high for a small oxy habit, he sounds a bit BUPE happy, just like my dr. Everyone I've ever spoken to says that less is more with suboxone. I have metabolic issues that mean I need higher doses but splitting my dose works for me when even one dose of 32 did not.

Stomach cramps are most likely constipation. I never got it from subs but a lot do. I think you should taper down fairly quickly and hope that you find a suitable taper plan to do so. I've been on it 3 years and do find increasing lack of motivation etc so j think ultimately, if you can get by with a short taper that would be ideal. Good luck.

 

[pooneilcorners]

Hi! You're dose is definitely too high. Way back when my habbit was only 40-60mg of oxy, 2mg of sub per day held me just fine. I also have experienced the negative feelings you describe. A combination of time and a lower dose should fix that. The longer you take the subs, however, the longer it will take to get off of them.

Another important fact is that cutting your dose is much more noticeable when the dose is lower (e.g. you won't feel much going from 10mg to 8mg but you'll really feel it cutting from 2 or 3 mg down to 1mg). Therefore, tapers usually become less and more spread out as you approach 0. For example, 2mg per day, then alternate 2mg and 1.5mg every other day for awhile, then just 1.5 every day, then do the same thing with 1.5 and 1, then 1 and .5 to .5, then .5 every other day, then every 3 days, you see the pattern... A taper like this is more for someone who has taken subs for a long time (a number of months or more). Some people are able to do rapid tapers (2 weeks or so) where this is not necessary.

Lastly, I second the point above that it takes a number of days to really feel the drop in dosage. That's why you should stick to the same dose or pattern (alternating like I described above) for a number of days (my preference is 2 weeks but probably more like 3 days for a rapid taper) before dropping again.

 

[Screaming_Skull]

That's WAAAY too much Sub for that amont of oxy. Lower it, ALOT. Go down to 4mg and start lowering from there, you would be suprised how little you can get by on. I too was started out on 16mg, too much, woulda been fine with 8mg, but I was iv'ing 60-180mg of oxy a day...60mg being a bad day. But ya, definalty lower that, but don't tell your doctor, it's an expenisve med so it's always nice to have a stockpile for when/if you relaspe. When my tolerance was just 60mg a day I got 4 Suboxne pills and snornted one 8mg one and was energetic as hell and nodding the hell out hard after I took two hits of mexican brick weed. Lower the dose, don't tell the doc. Total overkill for just 60mg of oxy a day. On the conversion chart it says 1mg of bupe equals 27.5mg of Oxy I think, so go down to 4mg for a little bit and go down more if you feel confortalble doing so and dont want to be on it for maintaince, because if you stick with 16mg a day, your gonna have a way worse time getting off that than 60mg of oxy, as in a month of hell followed by months of Paws as oppesed to the 3-7 day of just feeling shitty with the 60mg of oxy w/ds...honeslty I would look into kratom with that size habbit instead of Subs, seriiously.

 

[Zerwas]

That's WAAAY too much Sub for that amont of oxy. Lower it, ALOT. Go down to 4mg and start lowering from there, you would be suprised how little you can get by on.

This! Your doctor is not only useless but irresponsible to put you on such a ridiculous dose. You would basically become even more addicted to a much more potent (although partial agonist) opioid compared to Oxycodone.
With 60mg of Oxy you will probably feel fine on 2-3mg after getting used to the Bupe which can take up to a week so don't give up or redose much more if you do not feel 100% ok the first days.

 

[Znegative]

Anyways, my first question is, how long does it take to become physically addicted to Suboxone? I've only been taking it for three days, and part of me wants to try just stopping. My theory is that my body may already be done withdrawing from the Oxy, and maybe I haven't been on Suboxone long enough to be addicted yet. Is that completely stupid?

My next question is, does anyone have an idea of a schedule for the quickest way to comfortably taper down from Sub? Would it be like going down two milligrams every two days, or does it have to be longer than that? (I found a sample plan for tapering down on this website, but it was over many many weeks and I just don't want to do it that long: http://www.helpmegetoffdrugs.com/taper)

There's a common misconception that the way suboxone works is that your brain differentiates between the subs and the oxycodone (or any other opiate), and just masks the withdrawal symptoms. This isn't true, to your brain, an opiate/opioid is an opiate, it doesn't matter whether it's buprenorphine, a partial agonist, or oxycodone a full agonist. What is different though is how each drug is metabolized. Buprenorphine has a much longer half life, making it easier to taper off of (as the drug leaves your system slower). Honestly, IMO the faster the taper the better, because after time your body will get used to the longer half life (which also allows for the bupe to stack in your system), and once that happens, the withdrawals will last longer too. If you were to taper off in a week you would probably be fine, it might be a little harsh, but the acute symptoms (if you had any, you had a pretty light habbit to begin with) would be over fast.

Lastly, I've been super irritable, short-fused, and highly unmotivated since I got on Suboxone. I don't know if this is from the lack of getting high or an actual side effect of Sub, but I reeeeally can't take it. Would a BIGGER or SMALLER dose minimize this side effect? (I.e. maybe I'm irritable because I'm slightly withdrawing?) Would it help to start taking an antidepressant with it? I was thinking an antidepressant that deals with dopamine rather than an SSRI might help since Oxy messes up your dopamine system.

Also, super bad stomach cramps. Once again I don't know if that's a side effect of Sub or I'm withdrawing. Does Suboxone give you stomach cramps? Does it make you even more constipated that Oxy?

Sorry for the jumbled mess of questions.. I swear my brain isn't all there right now. I don't know what I'd do without the support of the people on this website, thanks so much everyone.

A lot of people find suboxone, and methadone for that matter, much more constipating than other full agonists. This is probably due to the fact that both have really long half lives. Also the irritability is probably a mixture of being caused by the suboxone, and from not using oxy. I've experienced it myself and know a lot of other people have too.

 

[AnythingEverything]

I was going to say similar ^^. It's not a case of getting 'over' the oxy withdrawals, opiates are opiates, whether partial or full agonists, and by going on bupe, even for a short time, you are still physically addicted and going to have to go through the withdrawal. However, given the relatively low dose you were on and the large dose of BUPE you've been given, I would definitely be reducing it right down and tapering off ASAP or it could potentially be worse than going cold turkey off the oxy you were taking. If you do feel you will relapse though then you do risk your dose going up of course, in which case, a very small amount or longer term SUBOXONE may be the way to stay safe. It's different for everyone.

Im here now, nearly 3 years stuck on 32mg and the road ahead seems so long i wish you luck.