A how-to guide to opiate detoxification.

[Dickon]

A How-to Guide to Opiate Detoxification.


Introduction


Although there are many different opiates and opioids (I shall abuse notation and lump them together under the single term opiates), all can lead to addiction and dependence. I shall discuss in this post the most common methods used to come off these drugs, and outline some specific detoxes. Let me add at this point that many of the drugs referred to are prescription only, and you are advised to see a doctor as with any drugs there are possible side-effects and dangers. If you proceed to follow any advice given it is imperative that you do you research. Harm reduction advice notwithstanding, there are many people who undergo successful home detoxes without medical intervention.


Do you want to detox? Why do you want to detox? What should you expect?


If you have clear answers to these questions then skip this section. Otherwise, seriously addressing these issues can make a huge difference to your chance of success. There is no getting over the fact that a) state of mind is of paramount importance; far more so than the actual method of detox used and b) chances are you will be stretched close to breaking point unless you have success at one of the "painless" methods described below. It is important to realise that dependence and addiction are two separate things. Dependence is the need to take the drug to avoid unpleasant withdrawal symptoms, and addiction is the obsessive and compulsive use of a substance to the exclusion of other aspects of life and in particular relationships with others. All most detoxes will do is break the dependence on opiates. The detox per se will not help with the addiction, but is an essential first step. I think having some clear idea of why you want to detox is helpful. Self-motivation is all but vital.


Other Options?


The other options are fairly limited, essentially carry on using the drugs you are using, or get a substitute prescription, usually methadone or buprenorphine if you are using illegal or street drugs. For some, the normalization of a chaotic life this can provide is beneficial, but for others it is a long-term trap, where there is little motivation to ever finally quit.


Detox Methods


I shall now outline a list of the more common and a couple of less common detox methods. Please bear in mind that there is no "one size fits all" solution, and I am only giving specifics to be used as rough guidelines that may prove more or less useful. My own prejudice, or perhaps "post-judice", in that it's a conclusion I've arrived at from experience, is that quicker detoxes are better than slow ones. Even the slow tapers I give are fairly quick by some standards.


Detoxing isn't rocket science. There are two basic ways to do it, a taper or a cold-turkey. The true cold turkey is the most primitive method: simply stop! There are several "weird and wacky" cold turkey variants, which we will deal with first, after which we will deal with more conventional home-methods.


Ibogaine


The latest "miracle cure" added to the pantheon is ibogaine. I have provided what I consider the most important information from what seems a reliable source below in an appendix to this post, together with sufficient references to articles etc. posted on DF to allow interested people to research this further. Please notice a less than one in three chance of "long-term" abstinence, and a one in three hundred chance of dying. I have no reason to doubt these numbers. I'd strongly advise not doing this at home. One in three hundred in a medical setting is likely to be reduced to one in two hundred or even one in one hundred (speculation) without proper testing and medical supervision.


Minority methods: LSD, DXM, Baclofen, GHB, Ketamine.


I can attest to someone experiencing an interruption in opiate usage after a large dose of LSD. I am inclined to think a powerful psychedelic experience can be helpful if someone genuinely seeks change. Someone on the forum has reported a similar interruption of opiate use with DXM, and DXM is being investigated for its ability to make a withdrawal less severe. Because of it's quick break down, it is sometimes mixed with an oxidaze inhibitor, e.g. quinidine. Another option is baclofen, which is showing some promise in reducing withdrawal symptoms. Ketamine and GHB have been mentioned by some as helpful in alleviating withdrawal symptoms. All these methods are outside the realm of my experience, and I have not found sufficient evidence to suggest anyone try these methods themselves; unless you've had no success with more conventional methods my advice would be to avoid them; at the very least do some serious research. I'd suggest the addiction > opiates section of the file archive as a good place to research DXM and Baclofen. This list is far from exhaustive.


Rapid/Ultra-Rapid Opiate Detox


The final minority detox is the rapid/ultra-rapid opiate detox; known as the Asturian method, UROD, Detox 5 or the Waissmann Method. This is in theory another "magic detox", but frankly it scares the hell out of me. Essentially you are heavily sedated, or put under anaesthesia, a nappy seems to be involved in many places, injected with opiate antagonists (naloxone or naltrexone) and wake up cured. Searching bulletin boards I have found horror stories, and the odd success story, although no one has claimed it painless as the providers do. The one suggestion here is, if you are considering it, do some research on the individual clinic you plan to use. Quality of care seems to vary widely. Post treatment there is usually a course of oral naltrexone, or a surgical procedure (under local anaesthetic) to deposit a "naltrexone implant" that will, in theory, render any attempted use of opiates futile by stopping them from working. The implant works for about 4 to 6 months. I've not come across much information about the merits of the implant over the naltrexone tablets, but it seems to me that if you were going to go down this path, the naltrexone implant is a far better solution than the tablets. Many people simply stop the tablets for a day or so, and then relapse. Most of the clinics I've come across that use naltrexone tablets insist on a "responsible person" to supervise the daily taking of them. But that would be little use when it came to an addict with a desire to use his or her drug of choice. I've heard stories of implants being ripped out, but the only details I could found were "very rare but has occurred" (from a power point presentation at the 2007 National Drug Treatment Conference. The link is: http://www.exchangesupplies.org/conf...colm_carr.html and has some information on the procedure, including gory images). The cost is also very high. With naltrexone, however administered there is also the danger of people taking stupid doses of opiates to "challenge" the blockade, and especially doing this in combination with other drugs.


I have a friend (still using) who tried this and described a scene of semi-lucid horror, which I have also heard elsewhere. On a scientific note I quote from the following Clinical Policy Bulletin (full text: http://www.aetna.com/cpb/medical/data/300_399/0317.html )


There is no scientifically-based evidence in the medical literature to substantiate that UROD is safe and effective as a clinical detoxification treatment. There is a reported risk of serious adverse events, including death with the use of anaesthetics, making the risk:benefit ratio of this detoxification procedure unacceptable. Besides direct causality associated with inadvertent anaesthetic overdose, there is also the risk of indirect causality related to possible aspiration and choking from emesis that may occur when an anaesthetized or heavily sedated individual is detoxified while asleep.


As this is something that is only going to be attempted under medical supervision, I shall leave interested readers to get professional medical advice. Bear in mind this is an expensive product, so make sure to get some impartial advice, rather than simply take the recommendation of the institution offering this detox modality, especially in light of the possibility of death mentioned above.


More conventional Detoxes for Home Use


Chances are you're going to resort to more conventional means. The fact that there are so many tapering strategies rather than one definitive method lends credence to the idea that no one way is universally better. To get some idea of the complexity of the issue, the following meta-analysis in the file archive runs to 219 pages, of which about 100 are relevant: http://www.drugs-forum.com/forum/loc...id=133&id=2708


In brief, there are 3 commonly used detox strategies; buprenorphine taper, methadone taper, and treatment with alpha-2 adrenergic agonists, principally lofexidine and clonidine, although alpha-2 adrenergic agonists can be combined with a taper, particularly at the end. Of course, one can in principal do a taper off heroin or any other opiate, How quickly you should taper is dependent very much on your psychology, i.e. determination, ability to endure suffering and also on the amount you are using and the length of time you've been using. I refer anyone to the above link for details, but there is no clear answer to what is "best practice". Lofexidine is preferable to clonidine, especially in a home-detox setting, as it does not cause low blood-pressure. Although one study (I don't have details to hand) suggested transitioning to buprenorphine made for a better detox, other studies seem to say there is little difference between coming off buprenorphine and methadone. One study suggested that a 7 day taper on buprenorphine was better than a 28 day one.


So, from here on in, I shall be guided by my reading, but I shall be more guided my own "clinical instincts" (which, as I am no medical doctor, you shall have to take with a pinch of salt). I suggest that anyone with strong views should use their own "clinical instincts" to manage their own detox. We are all ultimately the best judge of what we might need, and what we feel we can cope with.


I am now going to suggest some actual detoxes. If you are on other opiates, especially weaker ones like codeine, it might be impractical or impossible (due to availability) to switch to methadone, but the detox principles will generalise across other opiates. Doing a detox is much harder with street drugs where one doesn't know the purity. It is advisable to try to switch to something of known quality. Please read the caveat on clonidine that follows the description of the tapers if you choose to use it. I shall begin with "bare bones" descriptions of tapers available. Then I shall provide "accessories" (think of me as your fashion guide [on second thoughts don't, unless you want to look a mess]!) , i.e. adjunct medications and supplements which can be added to the basic taper. We shall of course address the issue of benzodiazepines, inter alia, at this point.


Long taper.


From a stable dose of methadone, reduce by 5 mg every 5 days until you hit 20mg. Then reduce by 2.5mg every 5 days and then stop. Although adding an alpha-2-adrenergic agonist to a slow taper is not shown to significantly increase success rates, I would nevertheless suggest consider taking 2 0.2mg lofexidine (Britlofex) tablets or 2 0.1 mg clonidine tablets at night when you reduce to 2.5 mg methadone or when you stop, if you are finding yourself in serious distress. These can be increased (by 2 tablets a day up to 8 tablets in line with details given in the "Fairly quick taper" below). If you do this you can take the tablets at a maximum dose for 7-10 days, and then taper off two at a time.


Taper with a switch to buprenorphine.


If you wish to switch to buprenorphine, reduce as above (if necessary) until you hit 20 mg, then after 5 days of methadone 20mg, wait between 36 and 72 hours (the longer the better) until you are experiencing as severe a withdrawal as possible then switch to 16mg mg buprenorphine a day. I have uploaded some guidelines for this transfer to the file archive, which I suggest you consult (http://www.drugs-forum.com/forum/loc...id=133&id=6430 ), as if you do not wait sufficiently long, or try to transfer too soon you are liable to experience precipitated withdrawals, which are unpleasant. Stabilise on the buprenorphine 16mg for 5 days, and then cut back by 1mg a day until on 2mg, then 1.5mg, 1mg, 0.5mg, and then stop. Depending on the pills you use this may necessitate dissolving a pill in some water, and measuring out doses with a syringe (i.e. dissolving an 8mg pill to make 8ml of solution. Then delivering a dose sublingually using the syringe).


Fairly quick taper.


From a stable dose of methadone, reduce by 5mg a day until you stop. From 20mg down use alpha-2-adrenergics (preferably lofexidine, if available, otherwise clonidine). On the 20mg methadone day take 2 0.2mg pills lofexidine (Britlofex) each pill being 0.2mg) or 2 0.1mg pills clonidine [clonidine is available in other doses, but I shall assume henceforth that a pill of lofexidine is 0.2mg and a pill of clonidine is 0.1mg] at bed time. On the 15mg day take 2 pills (either clonidine or lofexidine) at lunch time, and 2 at bed time (4 total). On the 10mg day take 2 pills each at lunch, tea time and bed time (6 pills total), and on the 5mg day take 2 pills each at breakfast, lunch, tea time, and bed time (8 pills total). Continue taking 8 pills a day for 8 more days, then 6 (miss out lunch pills), then 4 (miss out lunch and tea pills), then 2 (just take at night).


Very rapid taper - Good for other opiates where exact doses might be harder to calculate, or stabilization and gradual reduction is not plausible.


This is essentially the 20mg methadone down part of the last taper, with the 20mg dose replaced by your usual dose, 15mg by three-quarters of your usual dose, 10mg by a half of your usual dose, and 5mg by a quarter of your usual dose. The alpha-2-adrenergic agonists are given in the same 2 pills,4 pills, 6 pills, 8 pills for 8 days, 6 pills, 4 pills, 2 pills schedule.


[My cat has done variants of these last two, except his "very rapid taper" was 200mg, 100mg, 0 methadone, and only up to 6 clonidine pills a day. He got through, but says 200mg methadone a day or more may better be quit using the fairly quick taper]

Cold Turkey

As above, but take 3 lofexidine/clonidine pills on the last day of using opiates, 6 on the first day off, then 8 pills for 8 days, 6 pills, 4 pills, 2 pills.


Clonidine caveat


Although lofexidine is approved for home detox, clonidine is not. The main reason is that clonidine is a hypotensive (it lowers blood pressure). It is a very good idea to invest in a blood-pressure monitor and to miss a dose of clonidine if your blood pressure falls below 90/60 [These are APA guidelines]. Be very careful getting up from a bath, and ideally have someone with you at all times, or regularly checking on you if that is not possible. Also monitor your blood pressure as you come off the clonidine, as rebound hypertension (high blood pressure) is possible. If your blood pressure is unusually high, do not reduce the clonidine dose until it returns to a more normal level. I have included a fairly high dose of clonidine in the above tapers. For small habits, 6 or even 4 pills a day might suffice. One downside of clonidine is that it can sap your energy. Although I'd always suggest a helper to assist with any withdrawal, a helper would be especially encouraged for a withdrawal involving clonidine. At the very least, prepare by stocking up on food, any supplements you might want, etc.


Why 5 days in the slow taper?


Because 5 days is enough, by my reckoning, to adjust to a 5mg drop in dose. Ideally a slow taper should contain good days (i.e. the 5th day after a drop) but no "stagnation days"; hence I haven't said drop 5mg and stay on that for two weeks or a month, before making the next drop. In such a case all the days after the first 5 or 6 are essentially "stagnation days", where no progress is being made. We all know the saying "the devil makes work for idle hands". If we're sitting around doing nothing, with the end a long way off, we're likely to have a "fuck it" moment. I only know of one person who succeeded with a super-long (18 months) taper. But before he started he had already succeeded in the sense that he had reached an "enough is enough" point, which is of course far more important than the details of the individual detox.


Should I drink or smoke marijuana or take other drugs when I detox?


My own view is no; ideally not. Stimulant use is utterly contraindicated, as although it might temporarily relieve the stress and boredom, the comedown and/or anxiety will seek a natural resolution in opiate use. Alcohol is for the most part a no-no, as it lowers inhibitions and consequently resolve. A hangover is also not a good thing to add to a withdrawal. I think marijuana is something that does help certain people. If you have any tendency to paranoia, avoid it. I would personally advocate a period of total abstinence from all drugs, even if that is not your ultimate aim. The reason for this is not ideological, rather that for most people with addictive personalities, removing opiates will lead to other "addictive" behaviours, and the most natural ones are excessive drinking or other drug use. Addiction/dependence is not simply physical. A break from all addictive behaviour is the best way to recover. From a more ideological perspective, I think it is a good thing to "try" some real clean time; get to know yourself in your psychological "birthday suit" as it were!


Adjunct medications and supplements.


a) Benzodiazepines.


These are very often used to assist with the anxiety and sleeplessness of withdrawal. I have not seen conclusive evidence to sway me either way as to their efficacy. They will not help you sleep in serious withdrawal, at least not in "sensible" or even moderately stupid doses. They do seem to help somewhat with anxiety but the effect of benzodiazepines is still very "wrong"; they don't really help that much. On the down side, they will interfere with re-establishment of sleep-patterns, and some would contend the rebound insomnia/anxiety is not a good thing (I tend to think that such a rebound if it happens after w.d. is over is not a major problem), and lower inhibitions. I should caution against anyone who is not entirely confident of success taking benzodiazepines if there is any chance of them getting in a car to drive to score opiates. Driving while under the influence of benzodiazepines is totally dangerous especially if you are new to them, and I mean a totally different order of dangerous than driving after a few beers. My recommendations would be to take at most 20mg diazepam or 40mg temazepam at night, and if you are still anxious (which is unlikely) 10mg diazepam in the morning, or equivalent. I'd not recommend midazolam, alprazolam (Xanax) as they are short acting, and might have higher short-term addictive liability. Note that although these are low doses in some sense, 20mg diazepam (or 40mg temazepam) is a high dose, and will quite probably leave you with ataxia (difficulty walking). If this is a problem, (i.e. you are on your own) halve the dose I've given. If you are not affected (and be aware you might not be the best judge of that) take more. Do not take benzodiazepines if you do not feel anxious, or they are not helping you sleep.


b) Z-drugs


As an alternative to benzodiazepines, you could try Z-drugs. MY cat found zolpidem (Ambien) mildly useful in late withdrawal one time, but hated the metallic taste given from zopiclone (his taste and smell is always unduly heightened), even though he obtained some sleep from using it. Again be sensible; use low doses if you plan to use these things.


As a general guideline, chances are you simply won't sleep for a few days/weeks, or rather you may have a few totally sleepless nights and then a few with a laughably small amount of sleep. Sleep medication is unlikely to help much, and even if it does, the quality of sleep will probably be dire, and you'll wake feeling as bad as if you hadn't slept.


Obviously, if you choose to use either of the above, I strongly suggest you use either benzodiazepines or Z-drugs, not both.


c) Sedating anti-histamines.


I do not get on well with these, but using the sedating first-generation antihistamines can help with sleep and anxiety. One recommendation (see http://www.drugs-forum.com/forum/showthread.php?t=56011) is hydroxyzine (Vistaril) 50mg-100mg three times daily. It apparently loses it's effectiveness after 10 days, so use only at the critical juncture.


d) Imodium (loperamide)


This works well for diarrhoea. It is an opiate, but does not cross the blood-brain barrier.


e) Non-Steroidal Anti-Inflammatory Drugs [NSAIs]


I have used diclofenac and ibuprofen with some limited success for general aches and pains associated with withdrawal.




I have decided to add (almost) in it's entirety the following list of supplements from the following thread : http://www.drugs-forum.com/forum/showthread.php?t=56011 .This is the best information on detoxing I've seen on here, and I suggest you read it. I've edited out the mention of i.v. nutritional therapy that might be good in an inpatient setting, but will be impractical for a home detox. I've left in the general guide to nutrition.




Oral nutrition: Increase the right proteins!!!! Proteins are the building blocks for neurotransmitters and neurotransmitter receptors…as well as the building blocks for your natural opiate receptors




. For 3 weeks you must remove all red meats from your diet. Red meat has chemical components that increase inflammation and pain. Fish, chicken, eggs are good sources of protein. If you are having a hard time taking in solid foods go to a health food store and buy protein powders that can be made into smoothies or drinks. You absolutely must have increased protein intake…proteins are the building blocks for all enzymes, neurotransmitters, and enzyme receptors in the body. No chemical works in the body without receptors. Just like opioids have to have opioid receptors—which are down regulated during methadone use—this is the reason people have long-lasting pain and aggravation coming off methadone…this isn’t much of a problem with heroin use because of it’s short half-life…proteins are essential for the repair work in recovery…I now use a formulation made by Neuroresearch…their Neuroreplete/D-5 protein formulas works well for those coming off of methadone, methamphetamines and benzodiazepines or any drug for that matter…for more information on this product go to xxxxxxxxx or xxxxxxxxxx and try to find a doctor close to you that will help you get his product…in fact I treat all my methadone withdrawal patients with this formula




· L-Methionine—a sulfur bearing amino acid…necessary for the production of S-Adenosyl-methionine (SAM-e)…SAM-e is a necessary cofactor in the production of the master neurotransmitters—serotonin, dopamine, adrenalin, and nor-adrenalin…this must be added to any amino acid therapy directed at rebuilding neurotransmitter production and function…500 mg—two twice per day




· Increase your intake of raw fruits and vegetables…you get little or nothing from canned foods…fresh fruits and veges are loaded with fiber which help bind and remove toxins from your body…they also normalize gut function


· Stay off candy, and other sugar heavy foods


· Drink lots of good water, green teas are good for the antioxidants and anti-inflammatory properties…no cokes or soda waters for three weeks


· When capable you must start exercising…swimming is best because it is low impact exercise…yoga…tai chi…walking daily…detoxing or otherwise…exercise is a normal component of good health


Supplements: Some need less and some more…remember the efficacy of all nutrition and supplement use is ultimately guided by your genetics…and we are all different to some degree…This is the value of seeing a good Naturopathic physician in the state you are in…The fact is that very few Medical Doctors know anything about nutrition…70%-75% of the standard medical schools in this country have absolutely no nutritional classes what-so-ever…in the other 25 %--nutrition is often a 14-20 hour block of education and this is commonly an elective…Naturopathic physicians that are educated in a medical school environment are taught nutrition extensively with the associated biochemistry.




· I use the following with all types of drug and alcohol recovery….
·


* Multivitamin


with a strong mineral component: in gel caps only…an excellent quality multivitamin is absolutely necessary…remember that vitamins and minerals are cofactors/coenzymes for repair, healing, and normal function of the body…most times I have patients double up on multivitamins for the first 3-4 weeks


·


* Mineral complex


see above
·


* Fish oils, or flax seed oil


necessary for repair and proper function of cellular membranes…anti-inflammatory…these need to be mixed omega 3, omega 6, omega 9 oils—4000 to 6000 mg per day in split doses…although some can be purchased as liguids and mixed with your smoothies.


· If you don’t do the drinks…get proteins as


* free amino acids


…double up


·


* L-Glutamine 500mg caps


…at least 2000-3000 mg per day…split the dose so that your doing it at least twice per day…helps heal the gut and the building block for GABA…the primary inhibitory neurotransmitter…helps slow things down…Do not take GABA as a supplement…GABA is make in the brain…when out side the brain the molecule is to large to cross the blood brain barrier…the building block for GABA is L-Glutamine or Glutamic acid…these building blocks readily cross the blood brain barrier.


·


* Valarian Root 450 mg


: Botanical that reduces anxiety and helps one to sleep…Kava, Jamaican Dog Wood, Lemon Balm, Avena are all nervine botanicals which can be used together or by self…I find the doses for each individual varies but typically 1000 to 1500 mg every 4 hours.


·


* Melatonin


…dosages vary…this is a hormone released from the pinal gland in the human body at night time for sleep…this is essential for those coming off opioids…in my experience as little as 1 mg to 30 mg has been effective…do what you have to do…I’ve had addicts coming off $100.00 a day habits sleep 4 hours the first night…start low and add 3-5 mg every half-hour till sleep…research on healthy volunteers using up to 100 mg of melatonin in a single dose shows little side effects…Melatonin is also known as a very strong antioxidant with 1000 times the potency as Vit E…Take only at night when you would be going to bed at the regular time…the room must be dark…that’s the way this hormone is released in the natural state…


·


* Full Spectrum antioxidants:


relieves inflammation and helps normalize inflammatory pathways and reduces damaging molecules (free radicals) present in the system while detoxing


·


* Vitamin C:


2000-3000 mg per day divided doses…


·


* Reduced L-Glutathione 300mg per day:


Helps liver detox metabolites of methadone…Detoxing agents can be found in many products…most in combinations…


·


* Adrenal Support:


Research has shown that methadone, and drug use in general, has profound effects on the adrenal glands. In fact, research shows that there is a profound negative effect by methadone on the hypothalamic-pituitary-adrenal axis. This is why those that withdraw from methadone have protracted fatigue and problems with anxiety and insomnia. I often use freeze dried adrenal extracts in treatment with fairly good results. You’ll find these products listed under names such as Adrenal Plus, or Adrenplus…the starting dose is around 1000 mg per day in split doses.


·


* Milk Thistle with alpha-Lipoic Acid


is one combination that I use extensively---for liver repair and detoxification…1200 to 1500 mg of milk thistle and 400 mg of lipoic acid per day in split doses
This is the basics. There is absolutely no way to eliminate all the problems associated with withdrawal from methadone...one must have a supportive environment and often with daily visits from a compassionate health care provider…This will not kill you…it will be a miserable event…what kills most is the movement back to street drugs to ward off the side effects of withdrawal. If fact, cold turkey deaths coming off opioids and methadone are rare and usually associated with other health problems, or overdosing on prescription medications…withdrawal from methadone is much less of a risk than total withdrawal from alcohol. I wish you all luck on this endeavor…My compassion and empathy goes out to you…Ultimately, I know that you can do this…after all…it has to be done.


To this I'd add chamomile tea as a perfectly safe and mildly effective sleep-aid.


And finally (except for the appendix)!


I hope this guide has been useful. It is far from complete, in that just about anything and everything has been tried at some time as an aid to quitting. The main thing to remember is that quitting is not about quitting using some perfect “method”, it is about quitting any which way but use. I commend a terminator-like focus, a black sense of humour, and a smile. Also don't fear any “surrender moment” where you really feel you can't cope or go on any more. This can be empowering if you don't use and get through it. For anyone that is interested in my own most recent detox that I inflicted upon my cat, it is fairly fully documented here: http://www.drugs-forum.com/forum/showthread.php?t=69742


Best of luck, and talk about what you're going through. You're not alone!




Appendix - Ibogaine


I found the following information very useful : http://www.ibogaine.co.uk/ibogaine6.htm . Although I am no expert, my feeling is that the information here is good. One important tip mentioned is never to trust information from only one source if you are going to try ibogaine. One statistic is that one in three hundred people who have taken ibogaine have died. Particular risk factors mentioned are:


* having a pre-existing heart condition, sometimes one not detectable by EKG
* using opiates when on ibogaine, or shortly afterwards
* using the rootbark or iboga extract. Ibogaine HCl is statistically much safer
* taking ibogaine outside of a clinical facility. Persons taking ibogaine need constant supervision and, ideally, online heart monitoring


The following information I have taken from www.ibogaine.co.uk seems authoratative: I have posted the full text as post 32 of the following very good DF thread: http://www.drugs-forum.com/forum/showthread.php?t=4863


Ibogaine Treatment


(This article has been reproduced for interest value only).


Ibogaine, an indole alkaloid derived from an African plant source, has for many years been recognized for its ability to interrupt drug dependency. Specifically, it can be effective in the treatment of withdrawal from heroin, methadone, cocaine (inc. crack cocaine), amphetamine, and alcohol.


Although it is slightly psychoactive, ibogaine should not be confused with drugs like LSD or psilocybin. Ibogaine's effects are far longer lasting and can be intensely physical in some users. The drug should be treated with respect and not administered by persons unfamiliar with basic medical procedures. Because vomiting can be a problem with ibogaine treatment, persons administering should ensure especially that they are fully familiar with resuscitation procedures and have rapid access to the emergency services should they be required. It is important persons interested in receiving ibogaine treatment are properly screened. Failure to do so may have resulted in previous tragic accidents. Heart (EKG) and liver (Blood) screening are the absolute minimum.


PREPARATION OF THE CLIENT - The prospective client should attend several informal interviews to ensure he or she is fully aware of the following information relating to ibogaine treatment:


(i) - that ibogaine is principally a detox tool and that, whilst it can help with drug-craving for brief periods as well as help a person understand why they started using drugs, it will still be up to them to stay off. As a general rule, addicts who regard ibogaine as simply something which is supposed to "cure them" rarely have success.


(ii) - that ibogaine is an experimental medication, not recognized as a licensed medicine anywhere in the Western world, and that other options for treating their addiction exist.


(iii) - that deaths have occurred in association with ibogaine treatment, and that it must therefore be regarded as having a definite level of risk, though proper client screening procedures should be able to keep this to a minimum. Specifically, anyone with any history of heart problems should be very wary of taking ibogaine. In recent years there have been several reports of mysterious deaths associated with cardiac problems.


A basic level of physical and psychological screening is essential prior to a person being considered suitable for ibogaine treatment. A blood test should be undertaken to check for liver abnormalities and to ensure general health is good. An EKG should be undertaken to check heart function. Problems with the liver, heart or lungs should result in exclusion from treatment unless subsequent professional medical opinion advises to the contrary. Many long-term addicts may have developed medical health problems which would make ibogaine treatment in a non-clinical setting dangerous. These tests can be often be organized by drug dependency units or private doctors.


Attention should also be paid to the clients' mental state. Persons exhibiting signs of significant mental disorder should be excluded from treatment.


DOSAGE - Assuming the client is sufficiently well to be treated, their bodyweight in kilos should be measured, and a suitable dose of ibogaine calculated.


Pure ibogaine HCl is typically administered at doses of around 10 milligrams per kilo bodyweight (mg/k) for men, and 9 mg/k for women. To calculate the dose, multiply the client's bodyweight in kilos by either 10 (for men) or 9 (for women) and you will have the dose in milligrams.


Example: An 8 stone female alcoholic will require about 460mgs of ibogaine HCl, a little under half a gram. (8 stone x 14 = 112 lbs. 112 / 2.2 = 50.9 kgs. 50.9 x 9 = 458mgs)


Note that this is for pure ibogaine HCl, one of two forms of the drug commonly available in Europe. The other is the "Indra iboga extract," which is believed to be approximately one quarter the strength of pure HCl, meaning clients will require roughly four times the amount. Although the "Indra" product is becoming increasingly available in Europe, it is known to induce more vomiting than the HCl. In January 2000, a 40 year old heroin addict died in London after vomit clogged his airways some 40 hours after taking a dose of this extract.


For opiate addicts, such as those using heroin or methadone, the dose of ibogaine HCl is typically doubled, to around 20mg/k for men, and 18mg/k for women. This is because the opiates in a person's system partially block ibogaine's effect.


It is recommended that ibogaine only be given as a single dose, in the range of 9-10 mg/k. From what is known, this appears to be the safest way to take the drug, bearing in mind that higher doses can always be taken in subsequent sessions if necessary. When re-dosing, it is recommended to wait at least one month as ibogaine and its metabolites linger in the body.


TREATMENT PREPARATION - It is very important that the client's drug intake be regulated for 24 hours prior to taking the main dose of ibogaine. This will prevent the ibogaine from reacting with any other drugs still in the body, which research indicates may lead to adverse reactions. This means that no heroin, no cocaine and no other drugs should be taken for a minimum of 12 hours prior to taking the main dose of ibogaine. No methadone for a minimum of 24 hours. Drug use for the days prior to treatment should therefore be planned in advance to ensure this is possible. In addition, no stimulants should be taken for at least 24 hours prior to taking the main dose of ibogaine. Normal doses of benzodiazepines like valium can safely be taken prior to ibogaine to assist in reducing anxiety or to help the client sleep if necessary.


Ibogaine is recognized as having the ability to potentiate other drug reactions, meaning it is very important persons under its influence do not get access to drugs. Any level of opiate or cocaine usage whilst on ibogaine could be very dangerous.


24 hours prior to taking the main dose of ibogaine, a test dose of about 100mg of the drug should be taken. Allergic reactions have not been reported to the best of the writer's knowledge but, in the event of one occurring, the treatment should not proceed. Some minor level of ataxia, (difficulty in standing upright), nausea, and aural amplification may be experienced at this dose level. This is quite normal.


Food consumption should cease about 12 hours prior to the main dose of ibogaine being taken. To make this easy to bear, many people take ibogaine first thing in the morning, as a replacement for their morning fix. 1 hour prior to taking the main dose, an anti-nauseant such as domperidone (or similar travel sickness medication) may be taken to try and reduce nausea.


The treatment setting is important in that the client should feel relaxed and relatively easy in themselves. This will help to limit anxiety. Noise should be low throughout (ibogaine causes sounds to be heard much louder than usual), and the light level adjustable. Remember that ibogaine incapacitates some people for several days, so make sure that peaceful, dimly lit conditions can be maintained.


A "sitter" should be present with the client for the duration of the experience, which usually lasts between 20 and 30 hours, but in some cases has been known to go on for 3 days. This should ideally be someone experienced in ibogaine administration, or otherwise a close friend. It is unlikely much communication will be attempted in this time and the client should therefore be attended in peace. Requests for water may be fulfilled but nothing else should be taken.


THE EXPERIENCE - The client will likely experience the drug taking effect after between 30 minutes and 2 hours. Withdrawal symptoms should be eliminated or easily manageable. There will likely be ataxia (problems getting upright) accompanied by a buzzing noise in the ears. Sounds will become louder, bright light hard to bear. Some people report feeling nauseous and there may be a sensation of pulsing in the body, rather as though it were being "cranked up to a new frequency." These sensations are quite normal.


Vomiting within 3 hours of taking the main dose may result in some of the ibogaine leaving the body before it can be absorbed. In such circumstances, giving more may be considered or perhaps the treatment aborted. Examining the vomit may reveal if the drug has left the body. Be aware of the dangers of both overdosing and using stepped doses if considering giving more ibogaine to make up for that lost in vomit, especially if this is the first time someone has used the drug.


The experience of taking ibogaine varies so much from person to person, it is difficult to prejudge just what will happen for any one individual. However, there are generally two, distinct phases to the experience.


First, the "oneirophrenic" or "dream-creating" phase. This generally lasts several hours and usually consists of the user experiencing dream-like visions with eyelids closed, which disappear once the eyes are open. The visions may appear to be actual memories running, rather as though a film of one's life was being shown inside the head, or may take the form of characters acting out roles, rather as though a play was taking place inside the head. However, many people report no visual sensations and this is not a problem. People may experience feelings and sensations associated with childhood and early life.


Secondly, the "processing" phase, which follows once the first stage is concluded. This phase is characterized by high levels of mental activity - interiorized processing that allows the material revealed in the first phase to be assimilated and interpreted. People frequently experience comprehending for the first time the reasons why they became involved with drugs. Though ibogaine affects different people in different ways, the oneirophrenic phase typically starts 1-2 hours after taking the main dose, and the processing phase about 3-6 hours later, usually lasting for between 8 and 14 hours. People sometimes experience very negative feelings on ibogaine. If this appears to be happening, the person attending could try to give them reassurance that things are OK. Whatever arises will pass.


What is described above is a typical session but it is by no means unknown for people to be up and moving around within a few hours of taking the main dose, apparently having experienced very little. Alternately, some remain in bed for half a week. In addition, opiate addicts frequently experience little or nothing of the "oneirophrenic" phase. Sessions that are over quickly are usually less effective, and ibogaine does appear to have very little effect on some individuals, regardless of dose level.


Potential treatment providers please note: It is important to realize just how variable the drug's effects can be on different people. Tragic incidents can occur if safety procedures become lax after a string of successful treatments. Because, when ibogaine works, its effect can seem quite miraculous, it is very easy for people who are not medically experienced to start to relax pre-treatment screening procedures in their keenness to treat people and this is dangerous.


POST IBOGAINE - If the treatment has been successful, the client should be clean having experienced little or no withdrawal. In addition, many experience no desire to use drugs for a period of weeks afterward. Furthermore, some users report gaining insights into their drug-using behaviour. As a general rule, ibogaine is most effective for older addicts, a casual study indicating that those over 35 have a far better chance of staying clean than those in their twenties.


In cases where the treatment has been successful, but the client begins to experience the desire to use drugs again after some weeks, repeat dosing with ibogaine can be undertaken. Remember that persons not currently using opiates require ibogaine at a maximum dose of around 10mg/k. Re-dosing with ibogaine at less than one month intervals may be risky, as metabolites of the drug can remain in the body for this length of time.


Melatonin and B vitamins have been suggested as useful after using ibogaine. Some believe they help sustain the drug's effect.


POST IBOGAINE REHAB AND THERAPY - A single dose or multiple doses, given over a period, of ibogaine will occasionally be enough to keep someone off drugs permanently. But for most the truth is that, unless suitable post-ibogaine work is undertaken, a fairly rapid relapse to old ways is likely.


It is simply not possible to give guidelines that will be valid for everyone, for we are all different. However, for many, the addict should ideally enter rehabilitation as soon as possible after the treatment. In the writer's opinion, the best rehab program, and likely the one most suitable for those who have just taken ibogaine, is the Residential Addiction Foundation (RAF) program run by the Humaniversity in Egmont-aan-Zee, Holland, see www.humaniversity.nl for further details.


Other alternatives include any long-term (six months and up) residential rehab program available locally. Where residential rehab is not desirous, or not an option, suitable therapy should be seriously considered. Observations of the ethnic, religious use of the drug and first and second hand experience indicate to the writer that the most suitable types of therapy will be body-based and work around catharsis, confrontation and emotional release. "Talking only" type therapy, such as counselling may be effective in some cases but usually less so. Encounter therapy is often highly suitable for recovering addicts, as is primal therapy, bioenergetics, and indeed anything that sets out to assist the individual contact and release repressed emotions, frequently the root cause of addiction. More gentle, integrative work may also be useful. Dance structures such as 5 Rhythms or Biodanza may be helpful, either as a back-up to deeper work or on their own.


Attention should also be given to pleasure. Long term drug use will have likely had the effect of causing the addict's dopamine system to have been "hard-wired" to associate pleasure with drug use. This is the reason why many who have beaten addiction in the short term frequently relapse. A brief period of exposure to drug-using stimuli, especially at a time when a former addict feels vulnerable, often results in a return to addiction. Everyone needs pleasure and so the recovering addict must take steps to ensure they can get enjoyment out of life without using drugs. For the majority this will mean work on their sex lives. Sexual stimulation, and particularly orgasm, is the principle means by which the healthy body gains pleasure and releases tension. Work to increase the former user's ability to be intimate, both socially and sexually, is very important. Tantra workshops, touch therapy, or other intimacy-focussed processes are an excellent idea.


POST IBOGAINE PROBLEMS - Feelings of deep contentment - although less common with long term heroin users, many people using ibogaine feel in very high spirits for a period of days or sometimes weeks after taking ibogaine. Clients report feeling that their life is now totally straightened out, they don't need to do rehab, and everything is going to be just wonderful. Unfortunately, this feeling usually passes after a week or so. It is important to remember this as some people feel so good for a week or so after using ibogaine, they barely notice when they start to get the urge to use drugs again and so quickly relapse.


Learned behaviour or conditioning - ibogaine is widely noted as having the ability to "reset" a persons learned behaviour patterns, leaving them free from compulsive urges, drug-related or otherwise. Again, this usually only lasts for a period of days or weeks, and so attention should be paid to any drug-using stimuli in one's environment after this time.


Feelings of anxiety or paranoia - for some users the experience can prove quite harrowing. The drug can have the effect of radically altering the way a person looks at themselves and the world around them. Deep-rooted feelings of insecurity that may have been present since childhood can be uprooted and, when this happens, it can leave a person feeling disorientated and anxious for some time afterward. This will clear and is actually an indication that the drug has worked well.


Sleeplessness - many people find they require less sleep for a period of time post-ibogaine. This is quite normal.


RETURNING TO DRUG USE - If a return to drug use is anticipated post-ibogaine, it is imperative the client does not restart at the dosage level they were using prior to treatment. Ibogaine "resets" many brain functions relating to drug usage and to return to heavy usage could easily result in overdosing, and possibly death.




I cannot vouch for the post-Ibogaine rehab advice, but I like the idea of body-based therapy, and personally can give a thumbs-up to 5 Rhythms dancing, as something that has helped me in periods of abstinence. The idea of the benefit of confrontation in rehab I'd also be somewhat sceptical about. As for the advice on sex, I'd add a caveat. Relationships are one of the biggest causes of relapse, and in N.A. the advice is often given not to get into a relationship for at least one or two years after getting clean. Unfortunately perhaps, uncomplicated sex is not always available. Massage is perhaps a better alternative, if you do not have a stable partner.


Let me quote some statistics, again from the same site


When administered to persons seeking to beat addiction to heroin, methadone, cocaine or alcohol, a single dose of ibogaine typically achieves the following. Firstly, the complete removal or severe attenuation of the symptoms of drug withdrawal, allowing painless detoxification (occurs with approx. 90% of subjects). Secondly, the removal of the desire to use drugs for a period of between one week and three months (occurs with approx. 60% of subjects). Finally, the revealing of personal issues underlying drug-using behaviour, leading to long-term drug-abstinence (occurs with approx. 30% of subjects).


Obviously "long-term drug-abstinence" is a vague phrase, but this information clearly debunks the myth that ibogaine is a miracle cure. I'd have to put this in the "do not try this at home" category, unless absolutely desperate, at least not without prior medical screening and supervision. A one in three hundred chance of death is to my mind scary. Have you ever thrown 8 or 9 heads in a row? You want to risk your life it won't happen next time? That's the kind of odds we're dealing with.


There is a very long book for those that want to research further, downloadable in PDF format available here: http://www.drugs-forum.com/forum/sho...ighlight=iboga

Reputation Comments on this post:

	thorough and informative
	Excellent post. Keep up the good work!
	WHOAH! awesome thread! i especially like the fact that you included extensive ibogaine info.
	Very educational and helpful, thanks.
	God Bless you for taking the time to do this. I am sure this thread will be extremely helpful to many (I know it will h...
	Such a help
	this is just great
	excellent information, helpful
	for swim,the most informative & helpful posts on DF,thank-you so much;a great resource

[0utrider]

Also, for those interested in Iboga/Ibogaine:
Here you can find a collection of Iboga/Ibogaine documentaries. Quite interesting. You need BitTorrent to download it, which is easily found and not hard to install/configure.
The Download Link:IBOGA ebook and video collection about ibogaine
(http://thepiratebay.org/torrent/5036448/IBOGA_ebook_and_video_collection_about_ibogaine)
that's whats in it:

A collection of Videos and scientific articles about the Iboga, Ibogaine and its anti-addictive, healing properties.
Iboga/Ibogaine Scientific Articles & eBooks:

* eBook: Ibogaine - Proceedings from the First International Conference
* 200 PDFs, DOCs and PPTs, scientific literature, studies, ebooks, regimen and therapy descriptions, summaries, etc.

Ibogaine/Iboga Video Collection:

A video collection about the ANTIADDICTIVE medication: ibogaine, that can interrupt a 20 years long heroin addiction and raise the levels of neurotropic substances in the brain that is lowered by the narcotics to help the recovery. But more research i needed to be done, to ensure safe treatments and help against one of the most devastating sicknesses in the modern world: The addiction diseases.

*Facing the Habit 134 592 kb
*Ibogaine Reports - Beyond 2000. 92 915kb
*One Life Detox Or Die Ibogaine(BSLMasked) 107 800 kb
*Ibogaine - Rite of Passage 543 501 kb
*Tribe Babongo Iboga Initiation
*L'IBOGA Les Hommes du Bois Sacre (in French)
*Antropologia - Las puertas de la percepcion (in Spanish)

BitTorrent program:Azureus, now called Vuze : Bittorrent Client (others are also available, for every system and taste)
- if you do download it, please keep it seeding a bite (uploading to others who want it) or at best "forever", as this benefits everyone who is interested in this magic and very uncommon medicine.

If one has specific questions about Ibogaine/Iboga feel free to PM me. I'll answer if the answers can't be found out be reading this thread or using the search engine. Especially general advise is sth i think i can provide as well as place to go to / email / etc. where information about Iboga treatment can be found.

[oggy]

Oh cool Dickon, you used a lot of the thread I posted up a while back, I always thought it should have been a sticky.

Here's the link to the rest of it, it was my mother that magically came across it, so send her your love if you like.

How to go cold turkey from 150mg's of methadone! The easy way.

http://www.drugs-forum.com/forum/sho...408#post406408

[Adultswimmer]

I typed up a super long post but made a fatal error with a definition link I thought I had removed. I will try again.

First, thank you so much, Dickon, I appreciate the time and effort this took!

A friend has two other things to suggest that might help some. The first is Requip or other similar med for restless legs or even arms. Females can get that sensation in other annoying spots. It is fairly easy to get a script from a doc for this by describing the symptoms. My friend takes 2mg in the morning and 2 mg at night before bed, for 3-4 weeks. Once the symptoms subside (no apparent symptoms before the bedtime dose), she decreases it to 2mg only before bed for another 6-8 weeks. After that, she tapers to 1mg for one week, .5mg for one week, every other night (.5mg) for one week, then stops.

The other is DLPA or DL-Phenylalanine. This can be purchased at nutrition stores or online.
"All proteins in the body are made from amino acids. It is for this reason that amino acids are often referred to as the "building blocks" of proteins. Phenylalanine is one of the eight amino acids indispens-able (essential) in the diet of man. It comes in two forms, called "D" and "L." L (laevo, or left-handed) Phenylalanine is the form most commonly found in the high protein foods we eat, and is the form the body uses to make its own proteins. D -(dextro, or right-handed) Phenylalanine is a nearly identical molecule to the L form, but is an exact mirror image of it. D-Phenylalanine is found most abundantly in bacteria and plant tissue. The human body slowly converts D-Phenylalanine to L-Phenylalanine before it is utilized in known bodily functions."

DLPA has been around since the 70s but has recently been noticed. Many people use it for chronic pain and mood elevation but it can help with w/d symptoms too.
" DLPA taken orally in 375 mg. tablets, is a powerful analgesic. Its effect often equals or exceeds those of morphine or other opiate derivatives. It differs from the usual prescription drugs and over-the counter medicines in several critical ways:
* DLPA is non-addictive.
* DLPA's effects become stronger over time - patients do not de-velop tolerance to the pain-relieving effect.
* No adverse side effects, mental or physical, are associated with DLPA's use.
* Toxic overdose is impossible, and there is generally a lack of potential for abuse.
* DLPA can be combined with any other existing therapy - drugs, aspirin, acupuncture, chiropractic, etc., without adverse interac-tions, and often with benefits greater than could be obtained from either therapy alone.
* DLPA also has a strong antidepressant action - extremely important in the common instance where the sufferer of chronic pain is also a victim of depression.
* Perhaps most amazingly, the pain relief produced by DLPA can last far beyond the period in which it is taken. Some patients have reported that, following a week of DLPA use, pain relief continues for up to a month without additional medication of any kind. Pain control using DLPA can be very economical.

My friend suggests starting with 1,000mg for 3-4 weeks then tapering to 750mg for a few months. She still takes it off and on but I have other friends who have taken it for years with no side effects. It can increase energy without jitters, and it is great for those times when we work out a little too strenously. Aches and soreness the next day are greatly diminished. Great even if you aren't detoxing.

She also likes to have peanut butter, banana, and yogurt smoothies during detox. As Dickon mentioned, these nutrients are critical and this is a tasty way to get those down.

I hope this might be useful to someone.

Adultswimmer added 59 Minutes and 16 Seconds later...

I forgot to also mention that my friend likes to use a muscle or sports cream in conjunction with DLPA. While the benefits are limited (don't last long), each little bit can add up to helping a lot. Joints such as the knees are particularily affected so she applies a non-greasy odorless cream to the specific spots several times a day. Every hour or two during the day. According to her, treatment with this and DLPA take quite the edge off. After trying NSAIDs like ibuprofen and even prescription ones like Naprosyn, pain relievers like Tylenol, aspirin, or combos, she has found this to be the best by far.

Never one to have hot baths help in any significant way, she has found saunas to do a much better job. Since most of us do not have one in our house, you may need to go to a gym or hotel to use one. In fact, she likes to check into a hotel for 3 or 4 days to get over the worst with no distractions. By that I mean, no family, friends, or other visitors who want an explanation. And also away from routine responsibilities such as work and household chores. She finds it much easier to hole away, secrete the nastiness in private, pace when she has insomnia, and/or look like a whiter shade of pale.

Since many hotels have fitness centers and pools, saunas, room service, pay-for-view, etc, if you can afford it, this is the best way to go. Leave your iPhone and laptop at home but take your ipod and Wii if you can. Your own pillows and blanket, some good books, the rest of the items you need for detox, and you're as comfortable as you can possibly be.

Reputation Comments on this post:

	good information and well thought out post
	excellent information. posts like this are extremely beneficial to this site/to peoples recovery.

[bupaddict]

Can you use Tramadol to help with subutex withdrawals? SWIM used the search, couldnt find anything..

[OhCasey]

Originally Posted by bupaddict

Can you use Tramadol to help with subutex withdrawals? I've used the search, couldnt find anything..

Someone could but tramadol is an opioid itself so youd just be stepping down and prolonging the withdrawals though they wouldnt be as bad. If you spent a long time youd develop tramadol dependence and tramadol withdrawals are a monster all their own.

[bupaddict]

Originally Posted by OhCasey

Someone could but tramadol is an opioid itself so youd just be stepping down and prolonging the withdrawals though they wouldnt be as bad. If you spent a long time youd develop tramadol dependence and tramadol withdrawals are a monster all their own.

What if SWIM was to use Tramadol for a week and half till the main Sub withdrawals were over? does tramadol help alot with subutex withdrawal pains?

[OhCasey]

Originally Posted by bupaddict

What if SWIM was to use Tramadol for a week and half till the main Sub withdrawals were over? does tramadol help alot with subutex withdrawal pains?

If swim was going to step down from bupe with tramadol he wouldnt use tram for longer than a week but thats just him. It really depends on the dosage of bupe.

[Dickon]

One thing I have not seen much enough of on this site is specific buprenorphine tapering schedules. I would like to thank bananaskin for finding me this information on the official suboxone website. Although I have no experience of a buprenorphine detox (hah.....that's not self-incriminating!) my hunch from what I've come across on here is that 2mg is a rather high dose to jump from, certainly without alpha-2-adrenergic agonists (clonidine, lofexidine, etc.), but these schedules might be a starting point for those wanting to come off.

Dose		Reduction Schedules	of Buprenorphine
Day		Equal reduction schedule	50% reduction schedule
1-4		16mg	16mg
5-8		14mg	8mg
9-12		12mg	4mg
13-16		10mg	2mg
17-20		8mg	0mg
21-24		6mg	-
25-28		4mg	-
29-32		2mg	-
33-36		0mg	-

On the same site there are some shorter some reduction schedules. There is evidence here (http://www.drugs-forum.com/forum/loc...id=133&id=7179 ) that a 7 day taper is as effective as a 28 day one in achieving abstinence.

Dose		Reduction Schedules	of Buprenorphine
Day		10 day	7 day
1		8mg	8mg
2		8mg	6mg
3		4mg	4mg
4		4mg	4mg
5		4mg	2mg
6		2mg	2mg
7		2mg	0mg
8		2mg	-
9		2mg	-
10		0mg	-

Dickon

[rokman nash]

From personal experience, there is no corroborative info here, but go under 1.0 mgs for a day or two and it seems to help.


Good Thoughts

[brizer]

On my own I want to add that helps to detoxify from heroin. Drink plenty of fluids! This well assists in the removal of heroin from the body. Tea with jam, watermelon, and so on. Do not use diuretics. Sauna or bath very toxins through sweating. Bath with sea salts lets his feet and bone. There is a force of commitment ...

[gaulois]

SWIM said....

bupe/add:
SwimIs/ am steady on 2mg Suboxone. Went down from taking irregular doses 4-6 to sometimes 8. Once the pharmacist screwed up and gave swim 60 8mg tabs instead of the 2s ....never had that kind of "luck". Sometimes I took an 8mg orally, and strangely I would get more of an "effect".
Anyway, the problem being that swim was using the sub like an addict, instead of either tapering or maintenance. Wim moved back to his home in Maine, intending to taper rapidly. He did, and stayed off for 4-5 days. This did not workout and ended up back on the subs. But swim am at a steady slightly-less-than-2mgs. He take 1/2 in the am, and about 1/4 pill in the afternoon. So, simply being steady and on a low dose and being motivated to use the bupe as it is intended has made a huge difference. Swim want to taper, but having read a great deal about people like swim who have been on bupe for 3+yrs it is not easy. So, for myself, I am trying to stabilize at each reduction. Then when ready -decrease, and again stabilize.
I have used Tramadol. All the crap you hear about it not being addicted is BS. I dont know how the FDA did not arrest or fine the company that marketed Ultram. Swim took Tram for about 3 weeks once. When he stopped he went into the most weird scary w/d that swim have every had. His legs would not function. He was extremely weak and dizzy. He had to go back on, then went back on oxys then that was when he started Suboxone.
If swiy finds it necessary to use something other than bupe to taper- and I do not think there is anything much better than bupe imho. But if one is are serious about stopping, some people return to short acting opiates. What that does is take you from a long acting opiod w/d to a short acting opiod w/d. Problem- once you start on a short acting opiod (including tram) you start to get a buzz (unlike suboxone). Swim would like the buzz and would not want to taper, then end up on subs again. But should that be swiys preference- If swiy has been using bupe/sub for only a few months, the going to short acting might help. But should swiy be like swim, then even tapering using the short acting, since one has been on the long acting for so long- there is no avoiding the PAWS.
All this to say- Swim finds tramadol very scary, and also deceiving. Everyone is different though, as has been mentioned above. I knew someone taking small doses of tram legitimately for a long time and they stopped w/out much problem. But most people I know are freaked out about it like me.
I would suggest the taper Dilon's cat suggested w/suboxone. In swims/ case, am steady at 2. Then going to go very slow from there. I know a lot about
suboxone. Bupenorphine (bupe) and the treatement med suboxone-bupenorphine +Narcan have v. strong long lasting affinity to the opiate receptors. As a pain med- bupe is prescribed in tiny doses- .2mg. So, the true taper from bupe starts at 2mgs from my experience. There is a feeling of uncomfortability and fatigue as one goes from, say 8mg, down to 2, but the w/d really begins under the 2 (this is swims experience- everyone is different). Like Dilon's cat said, when you get to the fragment doses, might be better to mix w/ a bit of water. But I have taken fragments and it has worked. One of the several times I tried to stop, I had been off subs for about 4 weeks. I went to the hospital for kidney stones. I got a shot of Dilaudid (hydromorphone). Went home, woke up the next day totally destabilized, craving. Low and behold by chance swim found a fragment (about less than 1/4 of a 2mg tablet). He put it under his tongue. In an hour all w/d was gone, felt great, and next thing you know, unfortunately, was back on again. Just to illustrate how strong bupenorphine is. less than .5 mg. To reiterate: Swim had been shot up with dilaudid like 5 times while in the hospital. So, he had some nice doses of a normal and strong short acting opiate. Next day, he went into a mental w/d, which felt like a physical w/d,. Then less than (1/4 2mg tab,or .5 mg) bupe pulled me out, and I actually got an effect from it.
Don't hesitate to PM me if you want more info on Sub. It has both good and bad results.
PS- Dillon's cat: I have meant to say a few times that I really get a lot from your posts. Looks like you are an ocean fanatic like me.