Journal - Could someone please help me make a suboxone taper?

[mullet0224]

As I've stated in other posts, SWIM does between .2 and .4 of black tar heroin a day, smoked. Not sure of the purity.

SWIM now has suboxone and wants to taper, quickly but as painlessly as possible. He ideally wants to do it with between 4 and 6 8mg pills.
SWIM feels like this is really his chance to quit but he's never taken suboxone before. Based on his habit, could one of you helpful people here in the recovery section help me make a taper plan for SWIM?

Like, how much should he take the first day, and how quickly should he reduce it, etc.

SWIM has found some info on tapering, but he's hoping someone experienced with suboxone could help him design a taper tailor-made for his habit.

It was really hard for him to afford these pills, and he wants to do it right the first time. If need be, his friend has more pills he'll hold for SWIM... But SWIM may have trouble affording them. So if 6 pills isn't enough, he can possibly obtain more.

[Spucky]

"Normally" the Medics start with 4mg. if People are manifest addicted,
they wait 3-5 Hours and have a look how the Patient react.
After a few hours they have a look to the Biodata (Puls, Bloodpressure, etc.)
Sometimes they give a little bit more and sometimes not!

If Swiny have any question feel free to ask and please read the basics about Buprenorphin!

Please remind that Swim is not a Doc. and not responsible whats happen to swiny!

[electrolingus]

SWIM would recommend using the suboxone for no longer than two weeks. If SWIY has six 8mg tabs, the following taper should work for even the most 'proficient' user. One could easily get away with lower doses of suboxone. In fact, many detox facilities will use no more than 24mg of suboxone over a five day period. So adjust accordingly.
First day, 8mg (4mg BID/twice daily)
Day two - four, 6mg (or 3mg BID)
Day five - seven, 4mg (or 2mg BID)
Day eight - ten, 2mg (or 1mg BID)
Day eleven, 1mg (or 0.5mg BID)
Day twelve, 0.5mg
Day thirteen, 0.25mg
Day fourteen, <0.25mg

This taper will leave about 2mg left over to use as needed. One will be surprised at how a low dose of suboxone can actually keep a person 'comfortable'. The less suboxone one uses, the better off they will be. If the daily dose of suboxone is doing more than just taking the edge off, cut it back or dose bi-daily.

Good luck!

Reputation Comments on this post:

	perfect taper explanation
	Helpful advice, although I'd be tempted to say it's a little top heavy. 2mg could be used to double the duration of 1,0....

[mullet0224]

SWIelectrolingus, thats fucking wonderful. Exactly what I was looking for.
One more question and I think SWIMs gonna begin his taper exactly like that.
SWIMs read that taking suboxone too soon after using heroin can throw you into withdrawals.
But on wikipedia SWIM read this:

During the detox period of any situation, despite the evidence that suggests that the naloxone in Suboxone has no clinically significant effect, except for anecdotal reports of hypersensitivity in (if proven) rare cases, Subutex is urged over Suboxone by the manufacturer and users are likely to receive it during the first few days.

I know it says subutex is urged in the first few days, but it also says there is evidence that suggests that unless I'm very sensitive to naloxone, it won't have any significant effect.

So how long does SWIM really have to wait after his last dose of heroin to start?

[electrolingus]

The naloxone isn't well absorbed when administered sublingually. For SWIY's purpose and dose, it may as well not even exist. The best time to start the suboxone is at the first signs of DOC withdrawal (aprox. 18-24 hrs after last use or the day after the last use). It's that simple.

If one waits too long to take the suboxone, it has a tendency to not work as well. Once withdrawal sets in, opioid concentrations in the brain rapidly decrease. When opioid molecules leave the mu receptors, the buprenorphine molecules can then bind to the mu receptors by replacement rather than displacement. The increasing number of unoccupied mu receptors corresponds to an overall decline in opioid-induced activity and is why one should take the first dose of suboxone at the onset of withdrawal.

Reputation Comments on this post:

for being helpful and useful.

[mullet0224]

SWIM usually starts feeling withdrawals 12 hours after he smokes. He was hoping he could maybe take that extra 2mg of suboxone tonight at 11 or 12 to help him sleep.

He last used at 8:30 AM this morning.

Do you think that would throw him into unpleasant withdrawals, or he'd be good to go?

[electrolingus]

Ones first or initial dose of suboxone should be around 4 mg to achieve saturation at the receptor site. It's kinda like patching a hole in a leaky boat, put as much sealant on the hole as needed to seal it at first and then all you have to do is apply small amounts of sealant to take care of the smaller leaks that were missed or have re-emerged from the first attempt.

So, just start when SWIY physically feels like they need to start. It shouldn't matter if that happens to be this evening or tomorrow morning. If one is starting to withdrawal, you are IN withdrawal. Taking suboxone at this point will not put one further into withdrawal (you're already there, you dig?). The key is replacement rather than displacement at the mu receptor.

Just wanted to add that if one is not completely in withdrawal (but in withdrawal none the less) and needs something to take the edge off to get to sleep, 2mgs or less of suboxone may help. This way there won't be enough suboxone to displace the remaining activity at the heroin occupied receptor. Just re-start at day one of the taper plan the next day.

[mullet0224]

Mmkay, SWIMS gonna do it so wish him luck!

Tonight, 2mg of suboxone to "take the edge off and help him sleep", since sleeping is his worst problem with withdrawals.

Tomorrow morning, 4mg suboxone. Tomorrow night, 4mg suboxone.
And he'll follow the schedule to a tee.

SWIM imagines there will be minimal discomfort over the next 2 weeks.

[electrolingus]

Best of luck to your friend and please keep us posted.

Cheers!

electrolingus added 993 Minutes and 52 Seconds later...

Helpful advice, although I'd be tempted to say it's a little top heavy. 2mg could be used to double the duration of 1,0....

This is an excellent point.
The additional 2mgs was left over to be used PRN in the last few days of the taper. If these 2mgs are no longer available, SWIY may want to adjust the taper. Perhaps drop to 1mg at day ten and eleven. This will leave 1 mg to use PRN for the last couple of days.

[m.swinehart81]

I have heard from many people to use the COWS (clinical opiod withdrawl scale) to judge when to take the suboxone. From what I have been told you need to score a 26 on this worksheet in order to be ready to take the suboxone. Swim has done suboxone treatment and has done the switch from methadone to suboxone and the switch from heroin to suboxone. He didnt use this worksheet and was very sick. The last time he got on suboxone he did use it and it worked well for him. I dont know how everyone else on this forum feels about this but I will attach the link to the worksheet. Best of luck to your friend mullet!!

www.csam-asam.org/pdf/misc/COWS_induction_flow_sheet.doc

P.S.
It is in PDF format so you will have to have adobe reader on your computer

Reputation Comments on this post:

great suggestion

[electrolingus]

Originally Posted by m.swinehart81

I have heard from many people to use the COWS (clinical opiod withdrawl scale) to judge when to take the suboxone. From what I have been told you need to score a 26 on this worksheet in order to be ready to take the suboxone.

Not true. The recommended minimum COWS score for short acting opioids is 5-6 (preferably >10), not 26. It is recommended not to exceed a score of 24 before starting the transition to buprenorphine. 12-24 hours is within the clinical guidelines for beginning the transition. A score of 26 isn't even in the ball park, it's somewhere out in the parking lot!

This is the standard procedure for applying the COWS to avoid precipitated withdrawal during buprenorphine transition for both short-acting and long-acting opioids. (U.S.).
http://www.naabt.org/documents/NAABT_PrecipWD_HiRes.pdf

Reputation Comments on this post:

Excellent, referenced post. Your contributions in this thread are exceptional.

[m.swinehart81]

At the same time though swim can personally attest to the fact that he has tried to take suboxone while detoxing from heroin at about 24 hrs and got sick as hell. Im in no way trying to argue though. Just giving personal experience. The heroin swim uses is tar and I have heard that tar has a longer half life than other heroin. That may be complete nonsense though. I dont know that for a fact by any means

[mullet0224]

Yeah, SWIM waited like 12 hours and couldn't take the stress any more and took half a suboxone. Didn't help the withdrawals, made him hurt more for a little while.
Next day he took a suboxone and it helped quite a bit, then he slipped up and smoked .4 of heroin all at once.
Didn't really get high, probably due to the suboxone. Then, about 12 hours after his heroin slip up, about 24 hours after his last half a suboxone, he took another half.
Judging by the way he's feeling, he did it too soon after the heroin again.

It sucks, he really wanted to sleep tonight. His girlfriend gets out of detox tomorrow and its her birthday and he wanted to feel good and rested to pick her up.

[electrolingus]

Originally Posted by mullet0224

Yeah, SWIM waited like 12 hours and couldn't take the stress any more and took half a suboxone. Didn't help the withdrawals, made him hurt more for a little while.
Next day he took a suboxone and it helped quite a bit, then he slipped up and smoked .4 of heroin all at once.
Didn't really get high, probably due to the suboxone. Then, about 12 hours after his heroin slip up, about 24 hours after his last half a suboxone, he took another half.
Judging by the way he's feeling, he did it too soon after the heroin again.

First, how is SWIY taking the suboxone? Is he keeping it completely still under the tongue for as long as it takes for the tab to dissolve? One should also not drink or eat anything for at least 15 minutes after the tab has completely dissolved. If administered incorrectly, suboxone will be very ineffective.

Also, being a tad restless and experiencing cravings because one is no longer high does not constitute sufficient withdrawal. Waiting any less than 12 hours (or "like 12 hours") after the last opioid use to start suboxone is strongly inadvisable. 18-24 hours should be fine.

Suboxone does not work well as a temporary heroin substitute. Once one has decided to commit to suboxone and has begun the transition, getting high will be difficult to achieve and doing so will often make one even more uncomfortable. Keep in mind that one isn't going to feel terrific while detoxing from heroin with suboxone (especially during transition or day one of the taper plan). However, if used properly, suboxone is extremely effective in curbing the majority of the symptoms associated with opioid withdrawal.