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Opiate addiction Support for coping with Opiate addiction and Opiate addiction treatment.

 
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  #1  
Old 17-08-2012, 23:45
docdummy docdummy is offline
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Questions about suboxone taper

SWIM has been using heroin for approx. 6 weeks almost everyday no more than twice a day. Usually once a day of a 20 bag. SWIM wants to get off of it but is having a hard time with the cravings and has mild withdrawal symptoms (i.e. goosebumps, mild diarrhea, runny nose, restlessness...etc.). Since SWIM is having a hard time going cold turkey SWIM got an 8mg suboxone pill and figures maybe using that to help kick from the dope by doing a quick suboxone taper. SWIM's plan is to start taking the suboxone after 36 hours from last dose of heroin or when the w/d symptoms and cravings start to get uncomfortable. SWIM wants to start with 0.25-0.5mg suboxone for about 7 days until the heroin kick is over with. SWIM believes that since the frequency of use and length of use has been pretty minimal that he can use the suboxone below a therapeutic dose just to keep from thinking about using and getting through the hump of the kick.

Questions SWIM has are if after a week of suboxone use, could there be withdrawal symptoms from the suboxone itself? Also is there anyone who could suggest a taper schedule that could better match SWIM's habit? Is the dosing of the suboxone mentioned (0.25-0.5mg) too little or too much for the scenario provided? Any advice would be definitely appreciated. SWIM needs to stop using before it gets any worse than it already is. Please advise ASAP. Thank you.
  #2  
Old 18-08-2012, 01:09
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Re: Questions about suboxone taper

I feel for you...I don't have advice for you but I wish you the best through this shitty time!! I detoxed cold turkey off 70 ml methadone last november and it was not a good scene. I am now back on the morphine. I went 3 months clean and went back on morphine, where it all started. Please be strong and fight those cravings. It is so easy to fall in the same vicious cycle. I'm praying for you. I'm ready for round 2. So if the subs work that would be great to know. Keep us posted on your recovery!!
  #3  
Old 18-08-2012, 05:06
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Re: Questions about suboxone taper

thanks for the support. and I will keep you posted. please keep me in your prayers. but i still need help with answers. anyone. please.
  #4  
Old 18-08-2012, 05:51
Aminatrix Aminatrix is offline
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Re: Questions about suboxone taper

Do not take the suboxone until at least 30+ hours, until the withdrawals are unbearable. (Throwing up and or EXTREME pain/dysphoria is necessary. If you take it when you start to feel uncomfortable, you will get shot into hardcore full on withdrawal (well if you only take .25 then probably not full on, but then you will get worse, and possibly take more trying to feel better but really it will have the opposite effect).

Good luck, I recommend taking 2mg on day one, (AFTER at least severe withdrawal. take it 1mg at a time to see if it makes you worse, if so, wait until it starts to get better instead of worse before taking more)
1mg on day 2 (you will still have approx 1.25mg in your system from day 1),
.5mg on day 3,'
.5mg on day 4,
.25mg on day 5,
.25 on day 6,
0 on day 7
.25 on DAY 8
0,0,0,0,00000000000000000000

Using this method you will feel good, maybe perfectly good, or you might still feel kinda crummy, but definitely better than you would otherwise. You will have to deal with PAWS (post acute withdrawal syndrome) for some time afterwards, this is like a mild depression/gloom that makes it easy to relapse. Since you only used for 6 weeks straight this should go away in 6-8 weeks or less (in heavily addicted individuals this can last for 6months to 1year+).

Use this chart: (Chart and document uploaded, sorry I thought it would auto-merge DP)
http://www.naabt.org/documents/cows_...flow_sheet.pdf
I've been told to wait until you are 36+ on the chart, but if you wait until you are 28-30 you should be ok.

http://recoveringaddict.hubpages.com...oin--Oxycodone
This is a very good reference, but when it says 12-24 hours for heroin, you probably will have to wait at least 24 hours.

Side Note for smaller addictions:
Since you have only used for 6 weeks, if you use less than .25g/day you can fill out the chart, take 1mg of suboxone (after 12-18 hours) and see how you feel. Wait at least a full hour and then fill out the chart again. If the number goes down, take another .5mg, if it goes up, wait another hour and do the chart again, only taking more when the number is the same or lower as the starting read. Take up to 2mg on day 1, but if 1mg or 1.5mg takes away full WD symptoms, stay at that dose.

Last edited by Aminatrix; 18-08-2012 at 06:10.
  #5  
Old 18-08-2012, 05:56
Aminatrix Aminatrix is offline
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Re: Questions about suboxone taper

Buprenorphine, Suboxone guide: (It says wait until you are in beginnings of withdrawal, but it means actual withdrawal, not just crappy with mild aches. Follow the chart at the bottom of the post. Usually 24 hours is necessary after heroin use, 36 hours or more in heavy users (1g/day+)
Quote:
Buprenorphine works great and it can help you overcome an addiction while avoiding the pains of withdrawal. But you have to listen to your doctor and you have to wait until you're feeeling a little bit sick before taking that first dose. Here's why...
Suboxone is a partial opiate type medication that can be used as a substitute for drugs of abuse, like heroin, oxycontin, Percocet or other opiate drugs. By substituting onto buprenorphine (the active ingredient in suboxone) a physically dependent (addicted) person can switch to Suboxone, and if it is taken correctly, they will feel little or no withdrawal pain.
Suboxone works very similarly to methadone (but has several advantages over methadone) unlike methadone though, if Suboxone is taken incorrectly, or if it is abused, it can cause strong and even immediate symptoms of opiate withdrawal and detox.
Before you take a first dosage of Suboxone, you will have to abstain for a while from all other opiates, and you will have to be feeling the beginnings of withdrawal pain. If you do not abstain, or if you take Suboxone too soon after taking another opiate, you can enter into precipitated withdrawal (an immediate symptom of detox pains).
Why does taking Suboxone too soon after another opiate cause withdrawal pains?

Suboxone is said to have high affinity but low activity on the opiate type receptors in the brain (mu receptors).
High affinity means that it is very able to fill and activate the opiate receptors in the brain, and since it has a higher affinity for these receptors than other opiates (like heroin or methadone) if you take suboxone and another opiate together - it will even bump these other drugs out and fill the receptors instead.
Suboxone has a low activity at these receptors though. Although it will bump out other drugs, it cannot activate these receptors in the brain as strongly.
So…
If you take a drug like heroin, and then too soon after take suboxone, the suboxone will kick out the heroin, but it won’t be able to turn the opiate receptors on as well as the heroin. The brain (and body) experiences an immediate drop in the effects of the opiates. This drop in opiate levels of activation causes an immediate sensation of withdrawal.
When your doctor advises you to abstain from opiates for a certain period prior to taking a dose of Suboxone, it is very much in your best interest to listen and follow instructions. If you try to take another opiate drug too soon before your scheduled first dose of Suboxone, you will be making things much harder on yourself!
How long do you have to wait?

Your doctor will advise you on how long you will need to wait prior to taking a first dosage of Suboxone. In general, you will need to wait at least until you are feeling the initial sensations of withdrawal before you can safely take your first induction dosage.
The waiting times will vary depending on the drug of abuse. As a rough guideline, you can expect to have to abstain from:
  • Heroin – 12- 24 hours
  • Percocet, Vicodin, or Oxycodone – 12-24 hours
  • Crushed Oxycontin – 12 – 24 hours
  • Oxycontin 24 hours +
  • Methadone (must be at low dose) 36 hours (at least)
Source *National Alliance of Advocates for Buprenorphine Treatment http://www.naabt.org/faq_answers.cfm#21
It is in your best interest to follow the advice and instructions of your doctor, and wait until you are truly in the early stages of withdrawal prior to taking a first dosage of Suboxone. After you take Suboxone under supervision in the doctor's office, you can expect to feel much better within a very short time.
Suboxone can also create this precipitated withdrawal if abused by injection, due to the naloxone contained within.

COWS Withdrawal Scale Chart - Fill in the chart, if you are 35+ you can take suboxone without fear of precipitated withdrawal, if you are 25-30 you can take it with little fear of precipitated withdrawal, and if you do get it, it will only last a short period of time.
Attached Files
File Type: pdf cows_induction_flow_sheet.pdf (108.6 KB, 4 views)

Last edited by Aminatrix; 18-08-2012 at 06:04.
  #6  
Old 18-08-2012, 14:36
docdummy docdummy is offline
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Re: Questions about suboxone taper

Aminatrix,

Thank you so much for your prompt reply. It's good to know that there are people who are willing to share useful information and can understand how uneasy this can be. I am at about 18 hours since last use, and will try to wait it out as long as I can before taking the first dose of the bupe (at least 24 hours). Please keep me in your thoughts and prayers. I will keep you posted on my progress. Again thank you for your insight. It is definitely appreciated.
  #7  
Old 18-08-2012, 20:42
Aminatrix Aminatrix is offline
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Re: Questions about suboxone taper

You're very welcome I will be rooting for you!

Good luck, and come let us know how you're doing

BTW, you'll notice that you have some suboxone left over. This is so you have a bit left over just in case you need more on any day.

Rule of thumb with suboxone: Less is more. Always start with very small amounts, and let it work it's magic. It won't numb your brain though, the hardest part of switching to suboxone for me is the next day when my brain is running a million miles an hour, and it almost tricked me into thinking i was in WD. Any time you start feeling like that, just try switching your activity, do something different.
  #8  
Old 19-08-2012, 06:49
docdummy docdummy is offline
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Re: Questions about suboxone taper

How do i break this pill down to less to 1 mg? I got it down to 10 pieces which I would assume is approx .8mg.

docdummy added 422 Minutes and 34 Seconds later...

also how do I know I've taken enough?

Last edited by docdummy; 19-08-2012 at 06:49. Reason: Automerged Doublepost
  #9  
Old 19-08-2012, 07:13
Aminatrix Aminatrix is offline
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Re: Questions about suboxone taper

I usually wouuld break an 8mg in half, then break off as small pieces as i could, estimating the dosages at such small levels. You will know you have enough when you aren't in physical withdrawal anymore. it's normal to feel mentally like you crave/need heroin, but this goes away if you think about something else. basically on the first day, as long as you stop throwing up and you can actually sleep, then you have enough, the first day won't really ever feel that good, so don't waste too much trying to feel better on day 1

use the littlest that you can survive on. on day 2, take about 1/2 you did on day 1, and slowly increase to match day 1's dose IF YOU HAVE to. remember to wait two full hours after taking sub to make sure you feel it completely

you take it sub=lingual under the tongue right?
  #10  
Old 20-08-2012, 06:26
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Re: Questions about suboxone taper

yeah man. so far so good. day 2 complete. No kick. Not really any cravings either, and you're right about just focusing on something else and the thought going away. (but is this only being suppressed only til the suboxone is stopped?)

Like I said previously I got the tab to break down into 10 near equal portions. So I assume each piece is worth about 0.8mg...With that being said, SWIM took the first dose about 30 hours into the withdrawal. It wasn't bad but the discomfort, runny nose, dialated pupils, sweat, thinking, etc. was beginning to set. SWIM started with the dust that broke off from breaking the tab down, presumably <0.1mg sub-lingual and waited 30 mins. Felt better but not complete, So broke about 0.4mg (half of one piece) and went to bed.

Slept okay. Felt okay. Took the second dose about 24 hours later of 0.4mg (today). Still feel normal. Able to be active and not focused on dope. Though SWIM hopes even with these very low doses, the suboxone doesn't cause dependence on it.

SWIM plans to keep up with this for 7 days. and see what it feels like to go a day without the suboxone from day 4. If all is well from there SWIM will be in good shape, he prays for.

SWIM has a few questions. At such low doses can dependence on the bupe still occur?
Will there be cravings after the taper is over? How long to wait after day 4 if stopping usage for the day to wait since the half-life is so long?

So far so good. Aminatrix SWIM really appreciates your help. please help SWIM answer the questions if you can.

docdummy added 12 Minutes and 11 Seconds later...

will there be any kind of withdrawal from the bupe?

Last edited by docdummy; 20-08-2012 at 06:26. Reason: Automerged Doublepost
  #11  
Old 21-08-2012, 17:31
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Re: Questions about suboxone taper

imo if you stick to your 7 day plan,you should NOT have a dependace on suboxone

suboxone has a very long half life,so be careful not to stay on it too long mate

stay strong

all the best,constant limbo
  #12  
Old 21-08-2012, 17:54
Aberdonian Aberdonian is offline
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Re: Questions about suboxone taper

if you struggle breaking the pill into smaller amounts either weigh entire pill then crush it and work it out that way say pill weighed 800mg then 100mg=1mg sub , either tat or 0.2 and 0.4 mg temgesic pills are available online in india for a real cheap price which woul save a lot of hassle if your feeling shitty/shaky, either way i hope this works for you now before youve gone too far down h street , the further you go the longer it takes to get back to where u started, all the best from a random scotsman,A
  #13  
Old 21-08-2012, 18:45
Aminatrix Aminatrix is offline
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Re: Questions about suboxone taper

Hey sorry I was out for a day, sounds like you are doing very well

After you are all done and run out, you may have a bit of discomfort / anxiety / craving, but it won't be very bad. Just remember how much you REALLY don't want to get sick in the future, because that feeling is 100x worse.

Try to take less suboxone as the days go on, break it up into straight up crumbs, a tiny little bit will work

And yes, I agree with the poster above, if you only take Suboxone 7 or 8 days, you won't get a habit. (You might feel a bit of left over WD's from H, but not from Subs/bupe) If you take it 10-14 days that's pushing it, keep it under 10.
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Old 21-08-2012, 19:00
Aberdonian Aberdonian is offline
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Re: Questions about suboxone taper

iv done an 8 day taper with subutex before starting 12mg,day 2 16mg,day3 12mg,day4 8mg, day5 4mg, day 6 2mg, day 7 ,0.8 mg , day 8 0.4 mg then stepped off, i had very little wd just the tail end of my h wd i reckon, 1 night with no sleep then things got better by the day ! i think sub is a great detox drug,best detox i have done but its a bad maintenence drug as wd lasts ages in long term use from what iv seen , you should have no probs you havent been using long , my doses were highr on sub but i had been using loads of h and dhc for years ,your doing the right thing the right ay at the right time , take care buddy youll be just fine

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