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Hi Thatmonk. This is a long post, but I didn't want to exclude information that might be useful to you or others. I'm on Suboxone. I started at 12 mg a day and have decreased to 6 mg a day. When I try to go lower, I feel too much anxiety. I plan on tapering-off, but presently I am unemployed. The stress and anxiety of the job search makes this not the best time. Prior to taking Suboxone, I had been on other pain medicine - all due to a herniated disk in my lower back. Eventually I reached out for help with the pain meds addiction and back problem. I went to a medical practice that specializes in pain management and addiction. I found them by searching online for narcotics withdrawal help. They put me on Suboxone. After viewing an MRI results, they also gave an injection of anti-inflammation medicine near the herniated disk nerve endings. The injection lasts for a few months and completely removes all pain and inflammation.

My Suboxone prescription is renewed only by an office visit, usually monthly. The session lasts about 45 minutes with their Clinical Specialist/Therapist. She is very qualified and experienced with addiction treatment.

This Specialist told me a tapering-off plan based on Suboxone which has been successful with her other patients. The method uses a 3-day cycle. On days 1 and 2, decrease your normal daily intake by .5 mg, then on day 3 take the normal amount. For example, if the current daily intake is 6mg, take 5.5 mg on days 1 and 2, then on day 3 take 6 mg. Repeat the 3-day cycle over 2-weeks (5.5,5.5,6,5.5,5.5,6, etc.) For the next 2-week period, reduce all daily intakes by .5 mg. This works because Suboxone stays in the body more than a couple of days. On the 3-day cycle, little or no withdrawal symptoms should be felt on days 1 and 2. On day 3 when the symptoms are expected, you trick your body and return to the higher dose.

It seems the tapering-off plan takes too long, why not try a shorter period? The Specialist said a gradual tapering-off process is better so that a relapse to other narcotics or drugs is avoided. Also, a person with an addiction usually didn't get into that situation quickly - the process was most likely gradual as well. If a gradual taper-off process is used, the physical and psychological dependencies have a better chance of successful adjustment.

According to the Specialist, during the tapering-off process as the dose size decreases, there could be mild withdrawal symptoms, but these are usually manageable. Expect them. Other stresses may seem bigger than usual and challenge your coping skills. Hang in there. Consider taking an Advil or Alleve, it's amazing how much relief those give. After tapering-off, when there is no further routine Suboxone intake, there will be mild withdrawal symptoms that could last up to a few weeks. These will feel like a slight cold/flu. According to the Specialist's successful patients, don't give up if possible during this time. It does get better.

The Specialist suggests keeping Suboxone available after tapering-off. This helps in case the withdrawal intensity and symptoms are too much. Take the lowest dose you think is needed (.5 mg?). Relief should be felt within 15-20 minutes and the adverse symptoms should decrease - they may not disappear, but decide if you can tough it out or need to take more Suboxone. Don't think this is failure, it may be necessary to adjust your expectations of your body's withdrawal process from the power of the addiction.

Stretch it out: my idea of gaining control over my addiction is to stretch out time between taking Suboxone. I don't take all 6 mg at once each day. 2 mg can be taken every 8 hours. I found I could extend the times to 2 mg every 10 or 12 hours, etc. Stretching out the doses helps prepare for the tapering-off process. Keep busy and don't watch the clock.

Take only when needed: another idea I've used is to take a low dose of Suboxone only when initial withdrawal symptoms are felt. Instead of taking the pill at a certain time, question yourself if it's really necessary then, or could you wait a little longer? This idea reminds me of dieting: am I eating because the clock says it is meal time, or I am eating because my stomach is empty and growling?

For low daily doses of Suboxone, 2mg pills may be prescribed instead of 8 mg pills. Dividing the 8 mg pills into 4 parts may not always be equal, and this could impact your tapering-off process. The theory is to have better control of the intake amount when dealing with smaller doses. Perhaps buy a pill cutter at your pharmacy to have better control cutting either the 2 mg or 8 mg pills. FYI: the 2 mg pills might cost more.
Thanks for the reply Lain,

I'm actually half way through my taper now, under the guidance of my pain clinic doc. He thought it was an excellent idea to try tapering off and see how I manage my pain without analgesia. He recommended using clonodine to help with the withdrawal anxieties, you know the feeling... coming out of your skin... and it helps enormously. He thought Soboxone didn't seem to be very helpful, and besides you need to be in full blown withdrawals before they can start you in it, and in my case, there was no point in putting me through that as I'm not psychologically addicted. And there really is a difference. If I was addicted to anything, it was the pain relief the meds offered. I am actually really grateful for my pain meds, for they gave me the time I needed to make friends with the pain without it killing me. You know trigeminal neuralgia is also called "suicide disease" as the pain is so severe. In my opinion opiates are a stopgap to buy one time while you learn how to live with pain; or do allow you to die without pain. They are not a good long term plan!

When all this started, I came out of a sinus surgery that was supposed to fix the face and teeth pain I had. Instead I awoke after surgery in horrible pain about 8x worse than before. They prescribed percocet to manage the pain while I healed. Problem is that my body healed but my trigeminal nerve decided to just keep on transmitting the pain at the same enormous level. As I went from doc to doc trying to figure out what the hell went wrong, I survived day by day on percocet until after seeing a trigeminal neurologist nearly a year later, I was sent to a pain clinic, already dependent and still in horrible pain and facing extraordinary desperation. I also lost my home in the process and ended up in public housing, a read bummer in itself.

Indeed it was my desperation to avoid the pain and all the anxiety and fear it created that caused me to take the meds. It was literally as if I awoke in a nightmare that was waking reality. The pain was to bad, as was my mental health after the onslaught of drugs the pain clinic threw at me I was considering refusing food and dying, as living with such pain was just not an option.

The problem with opiate pain meds is that those first few weeks they work really well controlling pain. But after that everything slowly only gets worse and worse. Higher doses, worse side effects, greater lifestyle limitations. Only after a few years so you realize what has happened.

Fast forward five years... I've made friends with the pain and learned to live with it and even meditate extremely well with it, I can meditate on it now without aversion. (At least at 50mcg, I still have to see how I do free of meds, but I remain very hopeful and confident it will be just fine.) My problem was my anxiety and adversion to the pain than the pain itself.

Thanks for your thoughts. I'll be done with this process in another 20 days, as I am tapering down quite comfortable at 10% every six days. slow is indeed the best way to go. Other than being tired and feeling heavy, it's okay. It is inspiring to hear how much better you feel once off the meds. I am looking forward to a wonderful fall in NW Oregon mountains where I live.

:)
Hi Dolphinman,

Since posting this question I tapered down from 100ugh/hr to 37ugh/hr on fentnyl untill it become impossible to go lower. My HMO doctors got worried about me after two trips to ER in one day begging to be admitted as I couldn't care for myself loaded up on clonodine, neurontin and librium as I was. They sent me to an excellent pain clinic that also specializes in detoxing patients slowly, as opposed to the "rapid" detox which is little more than a revolving door = a cash cow for the clinics.

I was transitioned onto Subutex at 4mg and have subsequently tapered down to 0.5mg a day (note that 0.5mg Subutex equals about 10-12mg of oxycodone.) After holding at this for the last three weeks I'll continue slowly tapering down soon.

As to your withdrawal pains Dolphinman... Suboxone can be a wonderful tool if used correctly for getting one's life back together without cravings for narcotics. When it is time to start tapering off, a very slow and gradual pace is required. The longer we are on it, the longer we will need. Your body is telling you that you are going to fast, and going to fast puts your entire detox at risk. A person can tolerate such pain only so long until relaps occurs. There is no point or benefit in putting oneself in such agony.

Under the guidance of your doctor I would look towards a more gentle detox schedule, ever several weeks or months. It took a long time to build this dependance, therefore it will not go away overnight. In addition, the slower we detox the better we will do after we are detoxed. The PAWS will be less (Post Accute Withdrawal Symptoms.) Slow and gentle is the key.

I can understand wanting to get the drugs out of the system and to want to do it fast. But our brain is building new proteins and making massive and systemic changes. It takes a long time for these to occur. Our biology can't change overnight. You may wish to go to a higher dose where you are comfortable and then slowly taper down over time, as your system allows. Pushing so hard like this only puts your sobriety and detox at risk and makes one misearable to boot.

Suboxone/subutex are hard to get off of, like any opiate. A slow and gentle approach is the best and will assure the best outcome. I am glowing slowly and am very happy I did. It is not comfortable, but I can function and am not coming out of my skin and am not loaded up on a ton of stuff with their own physical dependence issues.

A final note: many docs hang their shingle out and claim to be "addiction specialists" after attending a short course on how to give suboxone. This does not make them addiction specialists. Many are simply in it for the money, sad as that fact is. It is critical to work with a qualified doctor or NP to support your process with wisdom and compassion, as well as having some friends to support you as well. Such a doctor ought to support a slow and gentle detox that allows you to remain fairly functional and even allow some periods of enjoyment and play... so important to recovery.

Good luck and best wishes





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