Taper Off Suboxone: Using the Films

When my Suboxone patients are ready to taper off the medication, I prefer to use the film. Since the film is no longer crumbling, patients can take sharp scissors or a knife and cut the films into smaller pieces roughly equal in size, ideal for a taper. Yes, I know the manufacturer says we shouldn’t cut the film or the tabs, because they have not done studies to see if the medication is equally distributed throughout the entire film or tablet. But cutting is a great way to taper, it seems to work, and everybody’s been doing it since Suboxone came out in 2003.

Most of my patients who successfully tapered off were on Suboxone at least two years, and did the work of counseling before attempting a taper. Most recent studies show high relapse rates if tapered too soon, probably because it takes time to get the essential counseling and make life changes that support a new life without drugs.

How long should the ideal taper take? It depends on the patient’s tolerance of opioid withdrawal symptoms. I’ve been telling patients four to six months is an average taper. I’ve been decreasing the dose by 2 mg every 2 weeks, until the patient is at 8mg or less. Most patients tolerate that fairly well, though patients differ markedly in their tolerance of withdrawal. At any time in the taper, if the patient starts feeling more withdrawal than they can tolerate, we can go back up a little, or plateau at a dose for a month or so.

Below 8mg, I reduce the dose more slowly, since each milligram is a bigger percent of the whole dose. I’ve been trying to decrease patients by 2mg every 4 weeks. This way when I see them every month, we talk about how they’re feeling, and if they’ve had a relapse (With any relapse to opioids, we go back up on the dose and work more on relapse prevention). For an 8mg film, this can be accomplished easily, by cutting the film into fourths. That’s a 25% drop in a month, or around 6.25% drop per week, at least at first. It’s common to have to stay on 4 or 2 mg for longer than a month.

Once the patient is down to 2mg, I switch to the 2mg film, and again have the patient divide it into fourths. I still try to drop by one-quarter of the film per month, meaning a half of a milligram decrease each month.

Sometimes we seem to get stuck at a dose. For example, I have a patient on a 2mg tab, which can be cut in half but is too small to reliably cut into fourths. He’s been trying to drop to 1mg but can’t tolerate staying at that dose for more than a day or two. So at his last visit, we decided he would alternate 1mg per day with 2mg per day. He did better with that, and now we are trying two days of 1mg and one day of 2mg, in a cycle every three days.

Then today, in my latest issue of American Journal on Addictions, there’s an article that throws a monkey wrench into my ideas around tapering.

This article has case reports of four patients who stopped Suboxone suddenly, unplanned. They were on doses ranging from 12mg per day to 30mg per day, and all four had only one or two days of mild opioid withdrawal, then felt fine.  The author concluded that these patients, “Showed no objective signs of opiate withdrawal following abrupt discontinuation of chronic buprenorphine/naloxone treatment…” The authors postulated that a prolonged taper might actually be harder on patients than stopping suddenly at a higher dose, based on these four case studies and other doctors’ impressions. Three of the four patients returned to buprenorphine/naloxone treatment when they had the opportunity, for fears of relapse, and the fourth was felt not to be appropriate for continued treatment with buprenorphine.

Could this be true? Might it be easier for patients to stop at a higher dose, rather than taper to a lower dose? Intuitively, a taper seems to be the best way to avoid withdrawal symptoms, but what if buprenorphine is different? It is an unusual drug. It’s a partial opioid agonist at the mu receptors, but it also has action on other opioid receptors. Might the action at other types of receptors be responsible for what was seen in those case studies? What about the monoproduct, Subutex?

The article’s authors conclude by recommending further studies comparing intensity of opioid withdrawal in patients undergoing rapid taper or sudden discontinuation versus patients undergoing a slower 28-day taper.

I’m so intrigued by these case reports that I’d love to see a large randomized trial to answer these questions. I have seen a few patients stop taking medication suddenly at higher doses and they said they didn’t have bad withdrawals…but then I have had many others who stopped suddenly and had terrible withdrawals.

Patients on Suboxone or Subutex, what do you think?

  1. Westermeyer, Joseph MD, et. al. “Course and Treatment of Buprenorphine/naloxone Withdrawal: An Analysis of Case Reports,” American Journal on Addictions, 2012, Vol. 21 (5) pp. 401-403.
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113 responses to this post.

  1. Posted by uknow16467432654 on August 21, 2012 at 2:37 am

    It varies for everyone but my experience and every bone in my body says something is wrong with this study. The inability to sleep and RLS are objective measurements and have been extremely pronounced for me coming off even the smallest doses. Something is very wrong here.

    Reply

    • Posted by ac3c9141724 on August 23, 2012 at 12:19 am

      And I’d like to add (same person, different name), I am not weak when it comes to coming off drugs, I have come off so many different things in my checkered past that I’ve grown to be good at it, lol. I can tolerate withdrawals that send others into detox facilities (not to say I don’t have my own limits!). Anyway, Suboxone has real and distinct withdrawals that, while not as severe as a full agonist, are simply not debatable. They are a milder, but very pronounced opiod withdrawals, as you would logically expect. I don’t know who did this study, but I suspect someone with a financial interest in Suboxone. That isn’t to say Suboxone isn’t a life saver, FAR preferable to methadone (at least in my opinion), and much safer than alternatives. That said, the last time I came off LESS THAN 2mg per day put me through a 2 week period of acute withdrawal syndrome that was … unmistakable. Following that was at least another couple weeks (or more) of not being fully ‘right’ in the head. The insomnia and RLS aren’t things you can psyche yourself into, and like I said, I tolerate some serious withdrawals pretty well, comparatively anyway.

      Reply

      • i’v been on suboxone for 2yrs. and i started with 1/2 of pill per day and did this for two years straigt with some temptations to use opiates sometime, but never did.
        Know i need to make another attempt to lower 1/2 to 1/2 of a 1/2 and did this for about one month then went to 1mg which is the film cut into eight peices and i’m taking one peice and my body has been experienceing pain in my arms and my legs, but i’m still take 1mg only and decided going to go off in about another month off 1mg dosage. you need to know that this is something you do not what to do anymore and i think you will be successful, but again i’m 47 and not in my 20’s.

      • Posted by jlo1965 on September 20, 2013 at 2:49 pm

        I’m 48 and have been on Suboxone for 5 years. I switched to it because I was taking too many opioid’s from a card accident and I felt it was turning into a problem. I did not do my due diligence and regret being on Suboxone. I have since moved to a small town in Ohio and no one here is licensed to prescribe this medication. I’ve been tapering on my own. I had plenty left because I was never taking the two strips a day that was prescribed. I just can’t seem to get off this stuff and I’m becoming suicidal over it. I also suffer from chronic pain that makes it even more difficult..

    • Posted by Kevin on June 8, 2013 at 5:50 pm

      I got the same issues, RLS and insomnia is NO JOKE! Everything else is a breeze. Does a slow tapper ever work for anyone out there? I’ve been Subing 8 to 16mg’s a day for the past 5 + years now, finally down to 2mg or less every 2 days for the past 3 months, but I’m expecting to go through hell soon once I run out. I was just curious if any hardcore opiate addicts (i.e. Vicodin to Heroin escalation) out there have ever TRULY made it through to the other side of sobriety? I’ve never seen anyone honestly succeed, just a lot of bs and self-deception. If anyone has any advice or words of encouragement I’d love to hear from you? I’ve tried to withdrawal many many times but have always failed, same with all my friends too. I’m currently 33 and just hoping to restart my life without the burden of needing to come up with the money every month for Suboxone. It’s like a conspiracy, but also a life saver. God I wish I never got so involved in this shit. Good luck to everyone trying, peace…

      Reply

      • Of course, I’m going to recommend you see a doctor to help you succeed. It isn’t only about getting off opioids, but staying off. You need to do some work on relapse prevention if you’ve not already done so. I’ve seen many people come off Suboxone. the ones that stay off are the ones who’ve prepared for the things that happen to us all, that can trigger relapses: medical issues like broken bones, strong & overwhelming negative emotion, and being around opioids.
        If you are on 2mg every other day, your doctor may recommend cutting to 1mg every other for several weeks, then 1mg every third day for several weeks before you stop completely.

      • Posted by Benjamin K. Phelps on June 9, 2013 at 12:45 pm

        @Kevin, PLEASE remember (not implying that you don’t, but just in case) that nobody conspired to get you on opioids, nor any of us. We ALL got on them & misused them ourselves, even if they were from a doctor for pain, originally. I’m not saying it’s our own “fault” that we have the propensity to be addicts, b/c I fully believe it’s there in some people genetically (if not all addicts). But never mind that – the medication-assisted treatment that exists is there to HELP us – NOT to hurt us or keep us addicted. It ONLY exists b/c abstinence-based treatments WERE NOT WORKING when they were all that was legal & available (at least not for 99% of the people trying them). Those folks were detoxed – got clean – but couldn’t STAY clean. I suspect that’s been your problem every time, too, just like mine. Personally, while I despise the money treatment costs, it’s a HELL of a lot cheaper than illicit drug use, whether heroin OR prescription opioids – including if you get them yourself from a pharmacy – b/c short-acting opioids like Vicodin & such, even though inexpensive, require WAY too many everyday & every dose to maintain an addiction for long, not to mention not being able to stay at the same maintenance dose-level. While I wish you the best & I HOPE you are able to stay clean w/o medication, if that’s what you want… I regret to say in the same breath that most opioid addicts are not able to permanently accomplish this. That’s NOT to discourage you from trying – what it IS meant to do is to tell you to GET THIS IN YOUR MIND: If you taper & either come all the way off OR get really low on your dose BUT find yourself craving harder than you can handle &/or you just KNOW inside that you’re about to relapse/not make it, GET BACK ON YOUR MEDICINE. Don’t wait until you’ve gone all the way to being physically dependent again on an illicit opioid to go back. Contrary to popular belief, you DO NOT have to be physically dependent on opioids to get back into MMT or Suboxone treatment by law. All you need is to have proof of previous treatment with either one & you are perfectly legal to begin treatment in an effort to avoid relapse. Now – some docs won’t follow this, despite that it’s 100% legal & isn’t in ANY WAY a type of loophole or shady practice – in fact, it’s actually a GREAT provision, b/c it means that you DON’T NEED to pop a dirty urine to get into treatment – you DON’T HAVE TO BREAK THE LAW in order to get help! That’s the way it’s supposed to be & should be. So I won’t keep going on & on; but PLEASE GET HELP if you get there & realize you’re not doing well! That’s all I want to drill in. Being on MAT is NOT evil, NOT shameful, & while it can be & often is expensive, it’s not the worst thing in the world to have to pay for… Medication for HIV or Hep C from dirty needles would be worse, in my mind – as would ending up dead or worse, incapacitated & unable to take care of yourself if you got a bad shot. Just take care of yourself & do the BEST you can do – & as Dr. Burson said – PREPARE YOURSELF any way that you can. It’s NOT going to be easy – not in the beginning (w/drawals), nor in the latter phase (staying clean after all that w/d stuff). Best wishes to you (& anybody else out there trying to accomplish this). I can appreciate how you feel – I’ve struggled paying for my methadone for 5 years now, being laid off several times during those years & only getting part-time work at most of the jobs I did manage to get since ’08. I will say this much, though: methadone is FAR cheaper than Suboxone! That’s a problem, too – but as long as it’s true, I just can’t even THINK about Suboxone or its generic. Not worth it to me.

      • Posted by Tiff on June 18, 2013 at 10:13 pm

        Kevin I am in the same boat. I am currently taking about 1.5 mgs a day and I just WANT TO GET OFF! I have been on them for about 3-4 years (with umm “breaks” in between) I am 32 years old and I truly wish I knew then what I know now..but then, would I have been ready? who knows. I just know that I am going to try. I am going to stay on this dose until my body adjusts, then try 1mg, then .75….and so forth. If you want to email me, perhaps we can give each other moral support. It is tiffanymaria666@gmail.com

      • Posted by kris on June 20, 2013 at 12:16 am

        I’ve been seriously addicted to morphine, oxycodone, hydrocodone, heroin etc. I did the rapid opiate detox under anesthetic and used suboxone to ween myself off for an extended period once before and I’m doing it again because after a few years of sobriety I relapsed after gettting out of an eating disorder clinic. Opiate addiction is tough. I went into it because I don’t feel safe like normal people do due to a traumatic childhood. Im always on edge and my fear response is hieghtened. Opiates made me feel safe. You can do it without them but I have only recently had any success after doing EMDR therapy which reconditions your brain and corrects the cause of addiction with respect to my particular type. I havent yet found 12 step meetings helpful but I have tried. It is a process. For the most part I have been taking my suboxone like just another med and go about my days sober depending on how you define it. My days used to be popping large amounts of pills every few hours, or smoking heroin and constantly smoking pot while eating myself into oblivion with every meal. I have maintained a 40 pound weight loss for over 2 years, havent touched pot in 6 years and am weening off the suboxone which at the moment is 0.5mg per day.

      • If you are taking your suboxone as prescribed (the phrase “for the most part” is a little worrisome…) and are not using other drugs, successful at maintaining weight loss…I think you are in successful recovery now, whether or not you get off suboxone at some point. congratulations!

      • kevin, same here. 5+ yrs of this stuff. first 3yrs I was buying it off the street. Back then I came off it twice for 2months. I was only doing ~1mg a day so after days 5-6 I felt 75% better and it improved with each day because of the low dose. The thing that always got me back was I wasnt off it long enough for my mind to get right. the depression I guess. It was a miracle drug in the beginning but slowly creeped up on me. As I always say “I’m not clean, I’m legal” lol

        This is my ADVICE/OPINION. I’ve been researching and I know a lot of people who are on it or have detoxed off it. Yes, taper. try to get below 2mg if u can. everyones half life is different and if urs was the max of 72hrs jumping at 2mg would mean it would take about 20 days for ur body to rid all of it from ur system. it wont be easy, save up and take time off work. you didnt get here over night, you wont get out of it over night. stay at each dose for no less than 2wks so the half lives can work out of your system. longer if you feel u need to. Do it at ur own pace. if u dont have to come off and dont feel ready, then don’t. I know I’m ready because I literally feel excited, curious of who I am without this shit in me.

        my friend jumped off cold turkey at 8mg, today is day15 and hes still in bad withdrawal. he refused to taper and got cocky. ive been on 8mg for 3yrs and right now im down to 3mg. so far ive done great. doing it with no doctor supervision because my dr refuses to help me taper. he has never weaned a patient off it, ever, he tells everyone they are on it for life no matter how much you beg. if you doctor works with you theres somethings he could prescribe to help you when the time comes. these doctors usually only know what the drug reps tell them, they all tell their patients theyll have no withdrawal if they taper enough. you will regardless but itll be for a shorter time period.

  2. Posted by Vincent on August 22, 2012 at 1:43 am

    Oh wow. This study is completely WRONG. Wherever they obtained their data I can assure you it is EXCEEDINGLY incorrect.

    I was on Suboxone tablets for 9 months in 2008 (16 mg per day). When I decided to stop taking the medication I reduced to 8 mg per day for one month, then stopped taking them altogether.

    The following 2 weeks were the worst 2 weeks of my life. I don’t think I slept more than one hour during any 24-hour period because the RLS was through the roof. I spent hours each day in hot then cold baths. I had no gastrointestinal problems, but had terrible hot/cold sweats, heart palpitations, extreme depression and even worse than the RLS was bone pain. All of my joints and bones felt like they were being crushed and twisted. After the 13th day things slowly got better, but it took a full month before the RLS was manageable and the depression lasted until 2010.

    In late 2011 I got on Suboxone again. This time the film. I take 16-24 mg per day depending on how I feel. I have found that (beyond eliminating my desire for opiates) Suboxone is the best anti-depressant I have ever taken. It’s a nice side effect. I absolutely dread the thought of coming off Suboxone again. Right now I make an excellent living as a software engineer and I am happy. I know myself very well and I am positive that if I get off Suboxone again I will be left with a hopeless depression once the hell of RLS and body aches have worn off.

    Reply

    • Posted by ac3c9141724 on August 23, 2012 at 12:09 am

      No kidding, you’re a software engineer too? I’ve been posting on the doc’s blog for a long time now, using a few different random aliases. Funny we’re both in the same profession. Anyway, you are 100% right, as I first indicated above (that’s me, different alias, was on my mobile device).

      Reply

      • Posted by anotherdev on April 30, 2013 at 12:10 am

        another software engineer here, and went on subs from a mild (15-20mg oxy a day) habit which i originally picked up because of depression. Sub was amazing and i’m not sure i’d still be here without it. Even if i have to look forward to life without it, that life is much better simply because i was able to live outside of craving and the drug-seeking behavior that goes with being unable to secure a safe, pure supply of medicine. Knowledge workers seem extra sensitive to this, possibly because the intense thought, lack of physical activity, and social isolation that is part of being a truly efficient software developer are all also all “triggers”.

        i hope, when I finally jump, the “loan” i took out with subs have worked, that my life (and my business I now own!) will provide the future i didn’t have, back in the dark days.

      • I am a software developer as well. I had a mild Vicodin habit and have been on Suboxone for that for about 16 months now. I am down to 2 mg per day on a slow taper. I am concerned about some day really needing opiates for pain relief. My doc says if I ever needed surgery or something I could wait about three days and then the pain meds would work. I just wonder if it’s really that simple after over a year of those opiate receptors being blocked! Has anyone on 2mg or less had experience stopping to take opiates and did they work?

      • Many patients down to 2mg per day still get anti-pain effect from full opioids. Certainly after two or three days other opioids would work for pain.

      • Thank you for your reply! Should I be concerned about the euphoric effects of opiates if I were to take them for pain? Say I came off sub for a minor surgery for three days, had the surgery, then had to take the meds for pain. Do you think I would get “high” from the opiate or is there something Subxone does to block that euphoric effect for a while even after it’s gone?

      • I was off Suboxone for 3 days before I went in for a gastric sleeve. They basically cut out 70% of my stomach laproscopically. I remember waking up in post-op feeling like I got donkey-kicked in the gut. 3 days was not long enough. They put me on a Dilauded pump for 2 days. I could dose every 10 minutes 1/4 of a cc and that barely took the edge off. I didn’t even feel the Dilauded. That’s the problem with Suboxone. You better not get injured or need surgery while on it because you will go through pain and there’s nothing they can do about it.

      • Posted by Benjamin K. Phelps on August 30, 2013 at 11:19 pm

        @Big Red: Not true. The deal is that you have to REMAIN on your maintenance medicine AND be given something (opioid) for pain IN ADDITION to that, in order to not be in w/d’s & barely getting any pain relief/on the edge of w/d’s all the time. My cousin cut off his thumb working construction while on MMT. The doc didn’t give him his methadone dose for the first 3 days, b/c of some (I believe incorrect) belief that it would alter the thickness of his blood, & they were trying to reattach the thumb & needed the blood not to coagulate. Nonetheless, during those days, he was maintained using a morphine pump – baseline dose at all times AND self-administer every 6 minutes as needed. My cousin was CLIMBING THE WALLS for the entire 3 days, b/c the morphine just couldn’t cover the methadone AND help w/pain. The reason? B/c there’s incomplete cross-tolerance between opioids. So let’s pretend that methadone activates (& this is PURELY fictional numbers) the delta opioid receptor 10%, the kappa 60%, & the mu 95%. Well, then morphine is substituted, let’s pretend it still activates the mu receptor a pretty high number of 92%, but the delta is only at 2% & the kappa at 35%. There’s BIG differences there, & you’ve grown accustomed to the higher numbers, which morphine cannot fill completely, at pretty much ANY dose… especially if it has almost no activity on one of the receptors where methadone has plenty or something of that nature. I have NO IDEA what the real numbers would look like, NOR do I know the complex nature of the relationship between the receptors & how 1 might affect the other as they’re activated. There are probably a few other factors involved, too. So my point is that b/c of the incomplete cross-tolerance, you must be tapered from one opioid sometimes, while the other is titrated, so as to not throw your body into a sort of shock from the change in receptor activation/antagonism.

        Now, those things said, keep in mind that tolerance IS going to affect your ability to get good relief from opioids. It doesn’t PREVENT relief, only makes it a bit more difficult to obtain at times. Adequate pain relief is DEFINITELY possible when on methadone, & less is known about Suboxone/buprenorphine when it comes to this, but it CAN be effectively controlled… especially since bupe is a pain reliever itself & has been used MUCH longer for that than for maintenance, at MUCH lower doses. At the super-high doses addicts take, it’s going to take super-high pain doses in all likelihood to control pain – doses many docs are unwilling to try, particularly if they aren’t well-versed in opioid dependence treatment & aware that we must be dosed closer together & at higher doses. These 2 factors SOUND like typical addict demands – MORE drug & MORE frequent dosing! But it just so happens to be very true for pain control during maintenance, & that can cause real issues with some docs. This need for more medicine, more frequently is WELL-documented information – I’m sure Dr. Burson can attest to this. Anyway, while it IS indeed harder to control pain while in maintenance if you have a stingy or uneducated doctor, it’s NOT impossible. And stopping your maintenance medication beforehand (by only a few days – in other words, not long enough to completely withdraw) is probably the WORST thing you can do for this process. You either need to be ALL THE WAY OFF – OR you need to be ALL THE WAY ON. Not in between.

      • Posted by dbc901028 on August 31, 2013 at 9:41 am

        @Benjamin K. Phelps: Buprenorphine (Suboxone) has an entirely different pharamcological profile than Methadone. Buprenorphine is a partial agonist, Methadone is a full agonist. And due to the extremely high affinity of Buprenorphine, it will prevent you from feeling the effects of full agonists, even if only a tiny bit remains in your system. Methadone, on the other hand, doesn’t matter so much, as it’s a full agonist (fully effective) pain reliever in itself, so it hardly matters if there is some left in your system or not.

      • PAIN CONTROL WHILE ON SUBOXONE
        There are misconceptions going on here. Methadone is a full blown Opiate Agonist, and in sufficient doses, it like Morphine will eliminate any amount of pain. However Mr. Phelps points on cross tolerances sounds reasonable. Stay on the Methadone and add another strong agonist to it.

        But Suboxone is a very strange different animal. At low mg doses it is relatively strong Agonist, but not as potent as Morphine, and will cling to those receptors very tenaciously. The solution is to quit the Suboxone, and in the very near term very high dosages of Morphine (say) will, at a sufficient dose (high enough so that Dr.’s not well versed in the issue may be scared to administer.) knock the Sub molecules off (overwhelm them) and fix your pain. Plus, it needs to come down as the Sub. leaves your body. That’s what my shrink told me and he is quite knowledgeable. I was expressing worry about if I crashed my motorcycle, broke a bunch of bones, and they couldn’t stop the pain for a few days.

        I’m afraid coming off some addictive drugs gets very hard as the dose gets smaller. And it’s not a pure percent game. Sub. Has that ceiling effect which I demonstrated totally through a memory lapse. I took 24mg in the morning (my dose, too high in retrospect), then a few hours later forgot, and took it again. 48mg! I didn’t feel a thing, and only noticed by counting the next day. But I had a friend, saw what dosages I was taking, and took 2mg., and through up and dry heaved all night. But there is MORE to getting to the low dosages than the growing pure Agonist nature at low doses, and % games.

        Methadone is notorious for the last few milligrams being the hard part. 100mg to 50mg could be done at once without severe withdrawal reactions. Getting down to 10mg. or so won’t be that hard. Get down near 5mg and LOOK OUT. Note that 100mg to 50mg. In one day is doable — 50%. You won’t feel great but not real sick. Go from 4mg to 2mg in one (50%), and you’ll find it feels like a BIG drop. You’ll be very sick. The solution is to pause at these points, just where your comfortable, for months. 6 months. The body starts to forget it used to be at 100mg., and you can start down again. Slow. The only thing that matters is not going up. Keep coming down. This is for someone with the time and money to do this. A 10 day, “jail house detox” is going to really hurt, but I’ve heard a lot less than a 1 day detox. LOL

        Here is the other data point I have which is off subject but illustrates the point. I managed to develop a whopping 8mg/day Xanax habit. I’d take 4mg in the morning and 4mg at night. Started as an OxyContin potentiators, then became the main problem. I’m also a software developer, and if I forgot my morning dose I’d be fine until 2:00pm, where I couldn’t fly around the keyboard due to twitching hand muscles. I’d have to go home and come back.

        Here is where I make my point. 8mg to 4mg was a week cake walk. 4mg to 2mg, was a breeze but less so. I got down to 0.75, and hit a wall. Some of the problem was not dividing the dosage 4 or more times per day. Xanax has a shrt half life. But I still would have been having trouble. 0.75mg., if that was as high I’d gotten would have been nothing. My Doc. switched me over to Librium (longer 1/2 life), at 50mg (2 x 25mg capsules), which is roughly a 1mg Xanax equivalent. I stayed there for 6 months, and he asked if I though I could get by on one. I just laughed. Why? Let’s just go to the 5mg dose and drop with that. After not too much time I was down to 15mg of Librium which is <0.5mg Xanax equivalents. I ran out, started to ask for another script, but didn't need to. DONE! But even with tranquilizers, where cold turkeying from 8 mg Xanax per day could literally kill you, if you've been on a high dose, for a long time (2 years for me), it doesn't get hard until the dose is so low a normal person would barely notice it.

        So there is something more than %s, agonist/antagonist, things at work here. I've never heard a good explanation. It was just told to me as a fact, and it indeed was. Hope all verbiage someone finds useful. At the very end (what you think! LOL), go REAL slow. STOP and just let time pass on the "trivial" dose. Then continue SLOWLY, keep repeating and you'll be off with no problem. DON'T RUSH THE VERY LOW DOSAGE PART OF THE TAPER, OR PAY THE PIPER.

  3. Posted by dbc910281927681 on August 23, 2012 at 3:48 am

    I was thinking about it, and it is possible that, depending on the dose, the many days it takes before you even start to feel withdrawal (due to the long half life) may be a part of the problem with this study. The (4? seriously?) patients in this study all came back, and I doubt it was for fear of relapse as much as the realization they were starting WDs. I still had every doctor say there is no or little withdrawal though… yet people at the same time remain on it for life. Let me tell you, being on Suboxone isn’t fun. You are constantly constipated. You don’t feel ‘natural’. You don’t have a libido. Nobody in their right mind would stay on for life by *choice*. They do so because they literally can’t live without it and *are* physically dependent on it and *will* experience opiate withdrawal syndrome. That said, it is mild, so tolerable, if you can take a couple weeks away from life. Lastly, do remember this study size is 4 random patients at some random clinic.

    I bet had he waited a few more days he would have seen objective signs of withdrawal. I mean, I can’t tell you how wrong it is to publish this in that magazine. I’m glad you reported on it. But it is wrong. Every long term Suboxone user will tell you that. Every one. Every one that has ever got off, or every one that has never gotten off.

    Reply

  4. Posted by dbc910281927681 on August 23, 2012 at 3:51 am

    And as I actually read the entirety of the article, I am now CERTAIN the doctor just didn’t wait long enough to see the WD symptoms. Since it is about coming off a relatively high dose vs tapering, that high dose caused the WDs to be delayed a considerable period. Simple math. End of story.

    Reply

    • Absolutely true. I read (unfortunately can’t identify the source but was reliable IMHO), that a girl on long term 8mg/day of Sub, quit cold turkey. It took two weeks, before the withdrawal syndrome started. LONG after she thought it wasn’t going to happen, and it was as bad as one would expect coming off 8mg after long term use. Her body probably broke it down slowly giving it a longer than typical half life.

      Reply

  5. Posted by Benjamin Keith Phelps on September 22, 2012 at 3:45 am

    This is reminiscent of the articles where I see docs say that the worst of methadone withdrawals are through in about 4-7 days. BULL! They’re just getting going good in 3 days, and it takes a solid month to come off, no matter what dose or how long I’ve been on it – though I’ve had it take a bit longer for the final weakness to go away when I was maintained longer. I’ve detoxed cold-turkey off 100mg/day, 20mg/day, 90mg/day, and 120mg/day. Each time, I was on at least 1.5 months, and the 120mg time I was on almost 10 years. That final time took closer to 60 days before I finally started being able to climb a set of stairs again without having to pull myself up with the hand rail, etc, even though the majority of the pain was gone by the end of 30 days. The RLS or akathisia was always HORRIBLE for me every single time, and lasted no less than 3 weeks on ANY occasion. For any doc to say that withdrawals are completed or that a person is considered detoxed by the end of a week is insane! I understand that tolerance has changed by that time – but that’s a different issue. If we were talking about reinstating an opioid dose after a week of abstinence, then we’d have a totally different discussion outcome here, and I’d agree we’d need to consider reducing the dose considerably, if not all the way back down to opioid-naive status. But the disappearance of withdrawal symptoms is by NO means complete after a week from methadone in the best of circumstances, and I don’t know of anyone that would say otherwise (who has gone through it without any medication to alleviate the symptoms, such as benzodiazepines, Lomotil, clonidine, etc.) Finally, I have noted that antihistimines and tri-cyclic antidepressants (which are very potent antihistimines themselves) potentiate the akathisia/RLS symptoms to unbearable levels. Allowing a doc to give me Benadryl/diphenhydramine, Vistaril/hydroxyzine, Phenergan/promethazine, Elavil/amitriptyline, Sinequan/doxepin, and even the tetra-cyclic a.d. Remeron/mirtazepine, etc will make me go just about mad with pain, RLS/akathisia, restlessness, etc and wish I were dead way more than I already would at that point. I have learned LONG ago to absolutely, positively, and without question TURN DOWN ANY of these items while in withdrawal, unless I want to suffer immensely even more than already happening. Just thought I’d put in my experiences here. Thanks for letting me share! And thanks for the work done on this site :0)

    Reply

    • Posted by Benjamin Keith Phelps on September 22, 2012 at 3:52 am

      Sorry – same poster as before – should’ve stated that I have no experience directly with tapering from buprenorphine except once when it was in trial phase (1996, Richmond, VA, Dr. P. Coleman, using Buprenex liquid under tongue for a few days – 3 doses/day, then 2/day, then finally 1/day. I relapsed to heroin several times during this “detox”, so my experience with it isn’t worth giving here. However, I just wanted to give some input on the idea of withdrawal being over in 4 days for a maintenance drug that normally lasts more than 24 hours. Buprenorphine is known to last for some people for 2 days before they need the next dose (and thus, they can dose every other day). That said, how would withdrawal POSSIBLY be over in 4 days?? This is literally nonsense, just based on logical thought with what we know about these medications, in my opinion. I don’t mean to sound like I’m criticizing the doctor here for asking the question (I appreciate immensely this site and its discussions!!), and I know bupe is a very different drug. But everyone I know that has been on maintenance with it has given consistent reports of bad withdrawals when they try to just stop abruptly. I don’t think we’re dealing with any kind of different animal when it comes to withdrawal than we are with the full agonist therapies. And from what we already know, the longer the half-life, the less intense the withdrawal, but the longer it takes – bottom line! But again, thanks for everything you do here, doctor.

      Reply

      • Posted by dbc910281927681 on September 22, 2012 at 4:55 pm

        Don’t be so hard on this doctor. If you read the article she is just describing the problems with having to cut Suboxone films (or break tabs) when, in-fact, the manufacturer does *not* recommend that because they can’t guarantee the medication is distributed equally throughout and/or the medication is absorbed as effectively.

        You are right, the WDs on Suboxone are not pleasant. It takes a week before you even see them. Then, even if you are below 2mg, you can look forward to a couple weeks of little to no sleep, RLS, etc.. etc… So, you’re right. However, compared to a full agonist, it is at least easier. Of course, if your duration of use has been long enough, it will be horrendous enough so that comparisons aren’t of much use.

        I’m glad they are coming out with 4mg and 12mg, people need this.

      • Posted by Benjamin K. Phelps on September 23, 2012 at 4:49 am

        dbc910281927681: Just in case you didn’t see, I did commend this doc for her work, which I GENUINELY and GREATLY appreciate (believe me, I know how much work in this field is needed and how much is lacking!!!) And I commented that I didn’t mean for this to come across as me questioning the doctor here for asking the question… I meant the comments about it being ludicrous for a doc to say 4 days to be aimed at the doc(s) that claimed this in the original “study” (which I don’t call a study – 4 people @ 4 days?? Get real!!) On the contrary, and let me be UTTERLY clear about this: I am ecstatic that Dr. Burson is doing this work, blogging on here, has the attitude she has from what I’ve read, and is so adamant about MAR, whether methadone or buprenorphine (or any other future treatments… even the Lazarus Project!) I am a certified methadone advocate through AATOD, and I appreciate ANY and EVERY advocate we have, official and unofficial, for this form of recovery. ALL forms of treatment that are approved are needed modalities, and none are THE answer – different treatments work for different people. I L-O-V-E-D her comments I read yesterday (can’t remember which article) – she said that she favors drug-free (abstinence-based) treatment as the ultimate…. (this initially disheartened me a little, I’ll admit…), BUT she went on to say that in EVERY treatment for ANY disease, she favors drug-free treatment. If she can control person X’s blood pressure w/diet and exercise and no drug regimen, that’s the ideal before placing that person on a drug protocol to achieve the same result. What a WONDERFUL way to put this! I’ve always had short patience for people that feel abstinence is the ONLY way; the “end-all-be-all” recovery method, and no other is valid. This flies in the face of evidence out there, and is harmful to those that could benefit from MAR but won’t engage b/c others scare them out of giving it a chance, as they did me for almost a decade – for which I now have a criminal history to show for that time from passing fake prescriptions and cannot find a job due to. Had I gone and gotten on a *properly run* MMT OTP back in 1995, I could have avoided *probably* all of those episodes of passing prescriptions, as my addiction started with heroin in DC and didn’t expand to prescription until I moved back to NC in 1996 to try to run away from drug availability (at that time, there was no dope in Morehead City, NC that I knew of.) Well, upon craving beyond what I could handle, I came up with this “master plan” to pass scripts, and now NUMEROUS felonies later, I sit with a record for life, 2 yrs 7 mos in prison under my belt for it, and desperately seeking work that I can’t find b/c nobody in this economy will hire a convicted felon anymore (the first decade wasn’t much of a problem.) I’ve now been clean since Dec 2003 with the help of a proper dose of methadone daily, and worked my way up to monthly takehomes, which took 4 years of compliance. That’s showing some serious progress, people! During that entire time (until 2008, when the economy crashed,) I was gainfully employed full-time with benefits, went to college, got off probation early, and even worked in a pharmacy (without incident! And yes, they knew my past.) It’s WAY past due for more people like Dr. Burson to be more commonplace in the medical community, and so, for the record, I THANK HER TO THE UTMOST EXTREME FOR THE WORK SHE DOES!!!

    • Here is a way to detox off Suboxone or Methadone that is not legal in our puritanical country that once had Prohibition, as a constitutional amendment. In Canada: Taper very low on Sub., then switch to very low dose morphine until the Sub. Is gone, then switch to Hydrocodone, taper more, and finally to Codeine, taper, and Codeine has a very short mild withdrawal syndrome.

      See a pattern here? It’s a bit of the US in reverse. If you go to a doctors office with a Hydrocodone addiction (some which are very low dosages), it is illegal for the doctor to prescribe Opiates for the addiction. So just tapering off the Hydrocodone is not an option. The doctor who prescribed it for the pain can taper. Or another doctor can find a “lower back” pain problem, prescribe it for that, then taper legally. But we’re rapidly approaching a nation wide database of controlled substance use. Most state have them. So it makes gaming the system, for the benefit of the patient. Of course it also protects SWIM from having 12 doctors prescribing to one person, and having no way to know.

      So this person with the minuscule Hydro addiction gets into a Sub program at 8mg/day (say). Yes that is dumb, but it’s done all the time. Then he is urged to get “stabilized” and get emotionally prepared to be clean. BUT NOW HE’S GOT A REAL MONKEY ON HIS BACK, and may never get clean. Nice system. Methadone Clinics are legal drug dealers with a money factory.

      Reply

      • Well, not only is it illegal to prescribe hydrocodone for a taper, but it’s short-acting, and thus harder to taper. Just like your doctor switched you from a very short-acting benzo (Xanax) to a long-acting benzo in order to taper, we do the same with buprenorphine. It’s very long-acting, and so can be dosed once a day or even less. With hydrocodone, the patient would have to dose repeatedly during the day. With addiction, that may make it impossible to stick with a taper. I suspect many addicts would end up taking a week’s worth of medication in a day or two. If we dosed with hydrocodone at the OTP daily, it wouldn’t work because the patients would be in withdrawal and looking for pills in 6-8 hours.
        It’s the pharmacology of methadone and buprenorphine that makes them work.

      • Posted by Benjamin K. Phelps on September 9, 2013 at 4:56 pm

        @Glenn, with all due respect, I take it pretty offensive that you call my working, legitimate, & legal treatment nothing more than legal drug dealing & a money factory. It may be that for those who don’t care to truly get clean & use it as a safety net for when the dope dealer is out of town, but for me & others like me, it’s been the ONLY treatment that EVER worked. And I did 6 inpatient, abstinence-based programs ranging from 3 weeks to 2 years. I also did 2 years & 7 months in prison for passing fake prescriptions, only to relapse in 3 weeks upon getting out. Methadone maintenance enabled me to get totally clean within less than a half year – it took me 5 months to find my stable dose. When I found it, ALL of my illicit drug use CEASED IMMEDIATELY. And it’s stayed that way now for 10 years. I don’t look at a medication regimen that’s followed EXACTLY as prescribed to be just another addiction. Addiction to methadone would indicate that I am harming myself but continue using it; that I’m spending money meant for bills & other responsibilities on it; that I’m escalating my dose constantly to get the same effect (when in fact, I’ve tapered down over these years); that I’m unable to handle my everyday responsibilities b/c of intoxication & my need for drugs. NONE OF THESE are true of me. The ONLY indication of addiction that matches up to me is the need for the medicine to avoid withdrawal symptoms. All that indicates though is a dependence on the medicine. Heck, I have a dependence on Nexium to prevent my heartburn – without which, I’m going to get sick! I’ll have heartburn with a vengeance if I don’t take it tomorrow morning. Same applies to methadone. So no, I didn’t trade one addiction for another. I traded one addiction for a medication regimen – one which I follow to a “tee”, & thus, I have earned take-home medication privileges that negate any need to go to the clinic daily. I don’t feel the urge to take all my methadone at one time to get off, nor to take it more often than prescribed. If I get a bottle of hydrocodone or hydromorphone (or any other short-acting opioid like you mentioned), as Dr Burson replied, I’d take ALL OF IT within a matter of hours. EVERY TIME. I’ve fought that battle for 8 years, time & again. I would buy 2 bundles of heroin (20 bags) thinking it would last me all week. WRONG. It would last me 24 hours or less… every single time. I passed scripts for 50 Lortab 10’s (hydrocodone 10mg, APAP 500mg), thinking it would last me days & days. WRONG. It would last me less than 24 hours every single time. That’s how I ended up having to pass a new script every single day for most of 1998 – I was taking between 40-50 Lortab 10’s a day. How I didn’t totally DEMOLISH my liver & kidneys with all that Tylenol, I have NO IDEA. I only pray it doesn’t show up that I’ve damaged some organ later in life from all that. But I’ve proven to myself & others over & over & over again that I CANNOT handle short-acting opioids responsibly – EXCEPT when I’m on methadone. Since being in treatment, I’ve been given short-acting opioids maybe 3 times in that 10 years for dental pain – usually 8-15 tablets at a time, & each time, I took it exactly as prescribed… b/c I knew that taking even the whole bottle wouldn’t do anything but make me nauseous, if anything at all. There was NO euphoria, which is EXACTLY how I wanted it to be. Euphoria from opioids is dangerous for me – once I feel it, I lose all control of myself & I do WHATEVER IT TAKES to keep it going for as long as possible – including risking going to jail for years & years at a time. So even though I’m not a doctor, I HIGHLY advise AGAINST using short-acting opioids to taper/detox. It’s illegal, but more importantly, if we could use them responsibly, we wouldn’t be called “addicts” & we wouldn’t have any issue to even be on this blog about. I doubt ANYBODY HERE can use them responsibly enough to follow your advice, in all honesty. And lastly, maintenance medicines (methadone & buprenorphine) are not a money racket in most OTPs & credible docs’ offices… They are LEGITIMATE, LEGAL (& while I’m at it, I’ll mention: THE BEST-STUDIED & POSSESS THE HIGHEST SUCCESS RATES) of ANY treatment for opioid addiction. They are NOT for everyone who misuses or abuses opioids a time or 2. They are for those who have been unsuccessful at getting clean using other (abstinence-based) methods & are desperate to get off the treadmill of opioid abuse & the damage they’re doing to themselves & others by their use. Some people will get back off them, some will stay on. But calling a treatment center basically a hustle – saying it’s nothing but a money factory, there to rip you off & keep you addicted (which is what you imply), is HIGHLY offensive to those of us who have triumphed over our addictions with the help of these medications & clinics. Methadone made possible for me to remain a free man in this world – to live OUTSIDE of a prison fence for the remainder of my life. And to remain ALIVE until I die of other causes, rather than dying from a needle in my arm w/some dirty heroin/cut mixture I’ve melted down in a spoon while in an alleyway or in my car somewhere, praying the cops don’t pull up on me before I can find a vein & get it injected. You may feel that way about it – but when it’s been the ONLY thing that could save your life & keep you a free man like it was for me, you APPRECIATE what it’s done for you, & you get really irritated when people come along & talk smack about it, as though it’s evil & of no good use. Being on maintenance isn’t all about getting right back off just as fast as possible. It’s about GETTING STABLE – & “stable” has NOTHING to do with meaning a stable flow of drug into your body – it means NOT using when something makes you mad, happy, elated, enraged, sad, & everywhere & anywhere in between. It means handling your responsibilities to yourself & your family members. It means working the job you’re supposed to be working to the highest extent you’re capable each day. And in relation to the drug itself, it means you’re not asking for increases OR decreases every other day or every other week anymore. It means you’ve realized & dealt with the fact that you’re not going to feel the methadone or Suboxone each day & you’ve stopped having that (“feeling it”) as your main objective in treatment. And once you’ve accomplished these things for a year at a MINIMUM, ONLY THEN should you EVEN START to THINK ABOUT when you may (& IF you may) want to taper at some point. Any time before that, you’re just basically wasting everyone’s time, b/c you’re almost guaranteed to run right back out there to do what you’ve been doing in the past. So again, I say with all due respect, MMT & buprenorphine treatments are GOD-SENDS to those of us who were at the end of our ropes. Please respect that by not coming onto Dr Burson’s SUPPORT blog, where we turn for support in our treatment matters, & sling names & accusations at the very thing we’re here to advocate for & dispel myths about – such as it being a money hustle, or impossible to come off of, or that it rots your bones/teeth, or that clinics just force you to stay on it, & all such garbage as that. I’ve been to MANY clinics – as a patient & as a guest-doser, & I’ve YET to find a single one who wouldn’t work with a patient to bring that patient off slowly WHEN THE PATIENT IS STABLE & READY. They’re not SUPPOSED to shove people towards a taper, no matter how that person is doing or any other details about his or her treatment – it’s NOT all about “gotta get off, gotta get off!!!” It’s about STAYING OFF ILLICIT DRUGS. If you can stay off them w/o these medicines, WONDERFUL! I’m right behind you, with all the support I can give! But for those of us who haven’t been able to do that any other way, these are life-savers, & we appreciate them each & every day. I appreciate you keeping that in mind & considering how it makes me feel when you refer to my treatment as some kind of underhanded hustle used to deceive people into becoming addicts of another drug. I went into my treatment with my eyes WIDE OPEN – knowing FULL WELL what methadone does, how it works, how much it would cost, & that I’d need to take it daily. B/c while it may be pennies a day for your dose, the doctor they hire to treat you, the nurses they hire to dispense your meds to you, the counselors they hire to counsel you, & the front desk person they hire to check you in each morning ARE NOT pennies a day. They demand a salary – one that’s NOT cheap. And they, like any other business in this country, are not business owners so they can give things away & take a loss. While there may be a few that are unnecessarily greedy in the fees they charge, many are not. And NOBODY was ever forced to enter into a clinic & pay ANY amount of money against their will for some methadone or buprenorphine. Anybody on it signed the papers acknowledging that it is a voluntary treatment that causes dependency on the medicine. That’s required by federal law (or at least, used to be…) Anybody looking to taper, if you’re ready, then by ALL MEANS, you have my full support & best wishes. But PLEASE don’t try to make those of us who aren’t looking to taper feel like we have something to be ashamed of. Getting the help I needed is the LAST thing I’ll EVER be ashamed of, regardless of what that help entailed.

  6. Posted by northcarolinamom on November 13, 2012 at 5:14 am

    1st time leavin a comment tho i been reading your blog more often than not for awhile now.
    As to the article, all i have to so is bologna! A little off topic but needed for why i say bologna. I have been on suboxone for 5 yrs now and see my doctor monthly for follow ups and it has saved my life. I was able to get back all the respect and trust I lost due to my obsession with pain killers, heroin, really anything that made everything go away and made me feel “great”.
    Long story short, I am able to enjoy life again, I now have a beautiful 3 yr old daughter and an amazing other half, which i could of never imagined 5 yrs ago. I have no desire to use at all and and all in all just enjoy life.
    That is up until about a week ago the yearly PA for suboxone came up, which i knew about and i made sure id have enough time to get the approval. Well things didnt go as i had thought they would and i am now suffering.
    Back to the article, I am on 24mgs a day and just stopping without any w/d would be heaven for anybody but its just not going to happen. I tried just 1 day and cannot take the RSL,insomnia, hot and cold sweats, rapidly brought on depression, nausea, runny nose, yawn attacks, watery eyes, severe anxiety ,etc, even contimplated suicide that day, and the half life isnt there with me, so i have been scraping every penny up i can find to pay cash for a few tablets just to take the edge off. This was just this past week and im gettin close to havin to go though it again but this time no way to get some of my prescription.i can only hope for some answers and that my doctor sorts out the issue because as of right now i am scared and will have no choice but a hospital and the 5 yrs i have had my life back may be lost for reasons NCDHHS wont give me.
    So if that article were true i wouldnt be in the situation im in. Especially after 5 yrs of hard work. Feels like it was all for nothing! Sorry this was more random then on topic but Im just very confused, scared and have no idea what im going to do.

    Reply

    • Hello and thanks for writing. I’ve had less problem getting a medicaid prior approval (I’m assuming that’s what you mean by PA) for suboxone, which is what you are talking about, I think, than I have getting a prior approval from insurance companies, so I don’t know what the problem is. Usually Medicaid will tell the doctor what the issue is. I’d recommend calling your doctor and asking for an update. Maybe they need more information?
      If there’s no way you can pay out of pocket, don’t forget about methadone. Some patients don’t like it as well as buprenorphine (Suboxone) but it works on the same priciple – long-acting opioid that replaces the endorphin your brain should be making, plus it blocks the effects of illicit opioids. Methadone is much cheaper, so don’t give up if you can’t access Suboxone!

      Reply

      • Posted by northcarolinamom on November 15, 2012 at 8:21 am

        Thank you for the advice. That is exactly what i was talking about with the PA. Ive been in treatment here for 3+ yrs continuing from another state and this is the 3rd PA ive had to get and the only one taking longer than 24 hrs. Ive been on the phone with the Dr and ACS Xerox or somthing like that, they do the PA’s or just the input into the system, im sure you know better than i do but thats the only contact i could find in regards to PA. They keep saying its missing a treatment plan . My Dr has sent everything they could possibly send. Atleast thats what im told when i call. Im not giving up thought, ive worked to hard to be where i am today. Fortunately right now i do have a little money to pay out of pocket but it wont last forever so i hope to get this resolved soon. As for methadone, My mom was in MMT for 11 yrs, I think, i could be mistaken but i know it was a long time and i really considered that route but by the time i lost everythign i had and everyone important to me, suboxone treatment was mentioned to me and was a better plan at the time. This is all scrambled and i hope it makes a little sense. I was never good at writing without it jumping all over the place.

      • Treatment plan could be the problem. Most Suboxone docs that I know don’t keep treatment plans. I don’t. that’s something seen more in the mental health field, and if you are seeing an individual counselor, that person may have a treatment plan. For my patients, on my progress note I list each problem separately, and indicate what I’ve talked about with the patient for each problem. Then I record the recommendations I have for that patient for each problem. Particularly if that patient is new, there’s much to write. I guess that’s my equivalent of a treatment plan, but in the medical world that I come from, it’s called a problem list. But after several years of Suboxone treatment, I suspect you don’t have much of a problem list. I’m guessing the plan is to continue what you’re doing.
        Sometimes the state looks at Suboxone treatment differently than other medical treatments, and they use terms that may be unfamiliar to medical doctors…but what they want is probably what your doctor calls a problem list.

      • Posted by dbc910281927681 on November 15, 2012 at 5:46 pm

        I had no idea Medicare would pay for Suboxone. No private insurer in my state, nor the state’s insurance (TennCare) will pay for it. In fact, my state’s health insurance also no longer pays for benzodiazepines, but that is nothing new, and according to them follows Medicare (http://www.tn.gov/tenncare/forms/phar20051229.pdf) .

        In general, I have a continued extreme distaste for private insurers – and government insurers for that matter. I used my private insurance ONCE in a visit to the ER because my blood pressure and heart rate alarmed my physician and he rushed me to the ER. I showed no drugs in my system, which was of course their first test I’m sure. They ran a bunch of other tests, told me to see a cardiologists (which I didn’t). Why? Because to help my stressed out self, my insurer started fighting with me trying to find some evidence I had high blood pressure prior to them starting to insure me. I won that battle, since there was no evidence, but it was not a fun battle and I still had a hefty part of a $5000 bill.

      • Posted by dbc910281927681 on November 15, 2012 at 5:51 pm

        To correct myself – they won’t pay for the TREATMENT. The actual pills usually do get paid for I think.

      • Methadone produces more than a little euphoria too. I loved the stuff. If I’d made it to 30 take homes per month, I’d still be on it. Probably forever. I think God intervened.

      • Posted by Benjamin K. Phelps on September 9, 2013 at 5:21 pm

        @Glenn, when on a stable dose, methadone does NOT produce any euphoria for most people. That may not be the case for EVERY person, per se, but it’s been shown MANY times over that euphoria is virtually non-existent with MMT. This has been done through motor-skill assessments, assessments of delayed-reaction times, & all such as these. MMT patients scored identical to people who’d not taken ANY drugs at all on these tests. But if you’re using other drugs such as benzodiazepines & such, then yes, you’re going to nod or act under the influence. By the fact that you say you couldn’t earn your way up on the takehomes, it would seem you must have been using or not compliant in SOME other way?? I have been at monthly takehomes, & not once did I EVER come up short on my daily dose, nor did I EVER take a dose early. Why? B/c it was of NO USE whatsoever. There was no “benefit” to taking extra, b/c methadone even blocks itself, just as it does other opioids. If you were on too LOW of a dose, that can also lead to feeling something each day when you dose, b/c your blood level fluctuates WAY too much. When you’re at a sufficient dose, the window between low & high blood levels closes & there’s very little difference – thus, you feel no fluctuation. And no, I’m NOT advocating the highest dose possible, nor am I saying go higher & higher, or even that you weren’t at a high enough dose… I don’t know. But I’m speculating at why you might have felt anything like you imply… B/c the fact of the matter is, for almost 50 years thousands of patients have taken methadone every single day, & it would be a MIGHTY BIG DUPE if we all were getting high & keeping it hidden from all the doctors for all this time, wouldn’t you think? It actually pissed me off quite a bit that I couldn’t feel my dose every morning when I first got into treatment… I kept wanting to feel it, so I asked for an increase regularly for the first few weeks – until I realized it was a lost cause, & I gave up on it. It was at that point that I realized that it was a GREAT thing that I couldn’t feel it everyday, b/c THAT’S EXACTLY how you end up in trouble – you get a few days’ worth of meds after a while as takehomes, & you take 3 doses at once in circumstances like that. So what a GREAT thing that I don’t feel it everyday… that I can be given a month’s worth of meds & take each day’s dose on the morning I’m supposed to take it, & not be fighting like hell against taking 2 or 3 other days’ doses along with it, leaving me stranded somewhere in the middle of the month, not knowing how in the heck I’ll make it until I go back to get more!

  7. Posted by Nancy White on November 24, 2012 at 6:46 pm

    hi janaburson I am a researcher and would love to discuss this issue of cutting the film to taper off. Are many doctors having to do this taper? Is it working in comparison to jumping off at 2mg. Nancy

    Reply

    • Stopping at 2mg is very hard for many patients, while others say they don’t have much withdrawal even if they stop at 8mg. It’s fascinating how different patients are in this respect.
      Empirically I would say I see better success with a slower taper. two milligrams seems to occupy a lot of receptors in many patients, and they really feel the drop from 2mg down to 1mg.
      I’m not aware of any research comparing taper protocols but it’s an area where we need more information.

      Reply

      • Posted by dbc913202819276813 on November 27, 2012 at 8:12 pm

        I continue to appreciate your blog.

        Indeed, it is fascinating how different people react to coming off Buprenorphine.

        As the doctor says, stopping at 2mg is difficult for many people, though is possible. I jumped off at 2mg, and for me the largest side effect was a lack of sleep, RLS, and other typical opiod withdrawal effects. However, they were minor compared to what I’ve personally been through before, therefore I was able to deal with them – and after a couple weeks, finally started to get some sleep. Yes, it took a while and wasn’t pleasant at all. In fact, it could drive a person near insane; as would any 2 week period spent without adequate sleep.

        I have no scientific basis for this, other than speculation and empirical knowledge, but I personally believe that it has to do with the level at which your brain was hooked on opiods/opiates before, and the duration of the Suboxone treatment. I believe Buprenorphine kind of halts everything, leaving your brain stuck at an opiod dependence level of X. This does go along with the known slow development of tolerance to Buprenorphine itself. Sure, X will increase a bit over time if Buprenorphine itself is used for a sustained period, or possibly at higher doses.

        Other than this though, I find that some people have much higher misery thresholds than others. Also, after being on Buprenorphine for a long period, most everyone gets sick of being on it. I can tell you that the 3rd week or so after I got off Buprenorphine, I felt better than I had in years. All my senses seem heightened, and I experienced what I felt to be a near religious awakening at the time. I could ‘feel’ again.. and oh man It felt soooooo good, something people should hear about, if for no other reason than encouragement; though they likely won’t believe it that first week or so ;p.

      • Hi, don’t know if this is still an active forum. I see most posts are over a year old, but figured I’d chime in for the hell of it. I started suboxone at 16mg/day for a 10-12 Vic a day habit from multiple shoulder surgeries. I was seeing a sub doctor who started me at 16mg and never asked me to lower my dose for an entire year. After moving to a different state and finding another Dr who was serious about my recovery we worked out a plan together. I did 1 month at 16mg, then dropped 2 mg every other month. It was working beautifully. I made it down to 4 mg and asked the Dr if I would experience WDs if I quit after 1 month at 2mgs. He said absolutely not. Especially given my health. I’m 32, active, athletic family man with a good job and strong support system. So after 3 weeks at 2mgs I decided to stop and see how things went. I felt great! By day 3 I was actually going hiking and enjoying my new found freedom! Then day 5 hit like a Mack truck. By day 7 I was in the most intense WDs of my life! I had quit Vicodin cold turkey many times and that was a walk in the park! I always knew if I made it past day 5-6 I was over the hump. With the subs I found myself in the ER on day 9 with sky high blood pressure, increased/erratic heart beat and debilitating migraines. Here I sit at day #11 and from everything that I’ve read, jumping from even .5mgs every 2-3 days will still cause severe WDs. That being said, I have found that all of the OTC and natural supplements are crap! I did however find that small doses of tramadol have been a life saver and have helped me stay somewhat sane through this. I only had a 3-4 day supply at 3 5mgs of tram a day and those 3 days, I maintained a normal life. Once I ran out, the WDs returned like Satan on a mission. I called my Sub Dr and asked to be put back in the program and he was happy to help. Still have 3 days to go until my appt though and 3 more days of this feel like an eternity. This time I’m going to widdle down t .25 mgs every 3 days before Jumping. Fingers crossed. My question is I guess, I read that a lot of people opt to stay on this at a low dose forever because it has caused permanent damage to their neurological systems. Is any of this true? I hope to God not! And with that, I wish you all luck. It’s nice to know I’m not alone. And one day WE CAN BE HAPPY AND DRUG FREE AGAIN!!!

      • You describe a situation that’s not uncommon, sadly. The last 2 mg can be difficult for many people. Then I’ve had other people who say it’s an easy withdrawal, which shows how different people can be.
        I wish there was a .5mg film or tab, so that we could drop to very low doses prior to complete cessation of buprenorphine. That may work better for some people, who must get a fairly large number of their opioid receptors covered by a very low dose of buprenorphine.
        some people do seen to be in long-term, subacute withdrawal for weeks to months after stopping opioids. That’s why we theorize it’s a metabolic disease: the body stops making its own endorphins, and the patient needs long-term replacement in order to feel OK. Just like underactive thyroid disease. We can’t know who will be like this. Maybe it’s genetic…Will those patients ever feel normal off medication? We don’t know that either. I know one patient who felt low-grade withdrawal for 9 months(!!!) but toughed it out and eventually felt OK. Most people would relapse if they felt that bad for that long. I don’t know how he was able to remain off opioids but eventually he felt OK.
        You are asking the questions to which many scientists are trying to answer with research. Hopefully we will know more in the future.
        I’ve had some patients get to a low dose, then dose every other day for a long while, then every three days, etc. There’s no evidence that this is more effective, but it’s another idea.

    • Posted by Lrm40 on January 7, 2013 at 11:11 am

      Hello.. I was on suboxone film for a total of four years.. I have currently weaned myself off from suboxone entirely and have seven days now “free” of suboxone..I began treatment by taking 24mgs of suboxone a day, and tapered down 4mgs a time every three months.. It worked well for
      Me with little discomfort.. In the past year I began taking 8mgs per day.. Every two or three months I began tapering down 1mg at a time, again with little to no discomfort.. After getting myself down to just 1mg of suboxone a day for a few months, I decided it was time to stop.. Even when I was only taking 1mg per day I still felt as if I was benefitting from the medication.. Thru my experience I believe tapering off in larger increments is only ok when done at the time
      of your highest points of suboxone
      Consumption (going from 24mgs to 20mgs etc.) And should only taper
      Off 1mg at a time once you’ve gotten down to 8mgs of suboxone per day.. I have been addicted to a laundry list of drugs in my 40 years on earth, and have gotten myself sober from every one of them.. After stopping the suboxone a week ago the wd’s got pretty intense and I was down to just an eigth of an 8mg dose per day before I stopped taking it.. I still have chronic sneezing, chronic restless legs, pains all over my body at times, exhausted but can’t sleep at all, and like said so many times before, my bones really do feel like they are “growing”, which feels crazy weird and uncomfortable..I know brighter days are ahead for me.. The self satisfaction I have knowing I kicked suboxone and am truly sober outweighs any wd or discomfort I felt while kicking..knowing I don’t have to spend my family’s money by the hundreds every month on treatment also outweighs the wd you feel..truly liberated and not dependent on anything.. Suboxone and therapy helped me remain and stay sober for the entire four years of treatment.. IMO stopping any narcotic at a higher dose opposed to tapering causes greater wd and discomfort.. The temporary pain is worth the outcome.. Complete abstinence

      Reply

      • Thank you for sharing your experience. It’s a great success story.

      • Posted by dbc913202819276813 on January 7, 2013 at 7:53 pm

        The one good thing about Suboxone / buprenorphine is that it really, really doesn’t get more pleasant with a higher dosage. In fact, you feel better doing less. That is the beauty of it. HOWEVER, I have encountered MANY people who taper down as low as 0.1mg and crazy stuff and still have trouble making the jump. My personal jump from 2mg was pretty bad, but nowhere near a full agonist. I would not recommend anyone jump from more than an average of 1mg per day (alternate day dosing). Also remember: It sure is nice to poop again! ;p

      • i hope you’re still around, i wanted to ask how your withdrawals are now that its been more than a week and you tapered? people usually only write online about it when they’re in the process of tapering or coming off. they don’t keep us folks updated after theyve been clean for so many days. Id like to hear from someone whose gotten more than a week in after tapering to a low dose. how are things???

  8. Posted by mat on March 20, 2013 at 4:54 am

    HI,

    The study is flawed, especially if they all got back on,. I suggest they never even began withdrawl. I know this because on my 4th day of wd, i felt fine. On the 7th day, that is where the insomnia started

    i was on subs for 5 years at 10mg, i tapered over 2 years down to .04mg.
    I had 30 days of insomnia where i got 1 hour of sleep every day for 30 days.

    matt

    Reply

    • Posted by db312 on March 20, 2013 at 9:28 pm

      Yep. I can attest to that! Depending on the end dose and dependence level, the symptoms probably don’t peak for a week, if not longer. It is one prolonged experience, with acute symptoms persisting strongly for a month.

      The text isn’t clear with ‘1 or 2 days of withdrawal’. If that was the first 1 or 2 days, and they weren’t kept off for at least a week or two, then this study is definitely useless.

      The study is probably sponsored by Reckitt Benckiser ;)

      Reply

    • Posted by db312 on March 20, 2013 at 9:36 pm

      (and I actually made a nearly identical comment when this article was first published, see above)

      Reply

  9. Posted by Susan on March 27, 2013 at 12:16 am

    I am currently tapering off of suboxone. 12 mg was my original dose and I was at that dose for 1 year. I have been at 8 mg for another year. In the past month I easily reduced my dose to 2 mg and started to think that ending my use of suboxone completely was going to be totally symptom-free. Then I went to 1 mg and that’s when the RLS, insomnia and sweats began. I’d grown so overly confident that it actually took me a full 24 hours to realize that the agony I was experiencing was withdrawal symptoms! In a panic, I took 4mg. This made me totally high which I find disturbing. Now I am nervous and scared about resuming my taper. I guess I will stay at 2 mg for awhile and then give 1 mg a try again when I feel up to it. I hope this info is of use to you & to other patients.

    Reply

    • Yes, your experience is commonly shared by other patients. That last 2-4mg seem to be the hardest. When you drop from 2mg to 1mg, it’s a 50% drop, much more than when you drop from 16mg to 12mg, for example

      Reply

      • Posted by Benjamin K. Phelps on March 27, 2013 at 9:54 pm

        Sorry, I just read the following reply from Dr Burson & realized she told you about the percentage thing already. Oh well – now you’ve heard it from 2 people :o) It IS true! I speak from experience myself.

      • Posted by db312 on March 27, 2013 at 10:44 pm

        I am not sure the % is the issue. After all, the drop from 16mg->8mg is 50%, and few feel it. The reductions throughout the dosing level are normally by %. Think about it.

    • Posted by uknow16467432654 on March 27, 2013 at 9:39 pm

      I have found, as have most others, that 2mg is the actual ceiling for almost everyone. Your story is common, and is my experience. People suggest tapering to at least 0.25mg before making the jump. Yes, it gets very problematic to dose this low.

      Reply

    • Posted by Benjamin K. Phelps on March 27, 2013 at 9:53 pm

      Susan, 2mg of buprenorphine IS NOT (!!!!) a low dose of the drug. Pain dosages of bupe run at 0.3mg (yes, that’s zero point three mg). So 2mg is actually a high dose, comparatively. Even moreso for the higher maintenance doses. When you have a higher amount of opioid in your receptors/body, you can handle much bigger drops at a time. So let’s say you’re at 8mg & you drop 2mg to 6mg. You’ve dropped only 25%. But when you’re at 4 & drop 2, you’ve dropped 50%! It gets worse as you get lower & thus, you have to drop according to percentage if you want to remain comfortable, rather than a steady number of milligrams to drop each time. Most people recommend no faster than between 10-20%, & some would say that’s generous. Many manufacturers of opioid drugs say in their prescribing information that ambulatory (in movement) patients can handle decreases of up to 40% daily opioid intake. However, keep in mind that this is for 12 hour extended release opioids OR short-acting (4-6 hour half-life), & NOT methadone or buprenorphine, both of which have half-lives that span about 24-36 or even more hours. The longer the half-life of the drug, the longer the withdrawal period, but the LESS intense the withdrawals. Don’t get me wrong – you’ll still wish you were dead! But it won’t be as bad as coming off heroin or oxycodone. So length of action of the drug & length of withdrawal are directly proportionate, while intensity of withdrawal is conversely proportionate to the length of time it takes to complete them. There will be a person here & there that claim that they believe methadone or bupe is worse than heroin. And to them, maybe that’s the case. But as far as the literature goes, & I’ve found this to be true – heroin withdrawal & other short-term opioids had me literally banging my head on a cinder-block wall & unable to get to the restroom (which was attached to my bedroom) before I messed up my pants for about 3-4 days, & then I was just really weak for another 3-4 days. Whereas methadone had me withdrawing for a month (more times than once), but I wasn’t ruining my underwear (sorry for the visual) & banging my head on brick walls. I strongly believe that most people who make that claim that methadone is worse (or bupe) are talking about the length of time being so long, not the intensity. The RLS is ALWAYS going to be THE worst thing – you can deal with the stomach issues, the hot/cold flashes, the insomnia, & all that. But the RLS stuff will make you an absolutely CRAZY person!! My best wishes go out to you! Take your taper S-L-O-W-L-Y & you will indeed be able to taper w/o much issue. Just remember – keep a percentage, not a milligram amount in mind to drop by each time. If Dr Burson disagrees w/me here, I’m hoping she’ll chime in.

      Reply

      • Posted by db312 on March 27, 2013 at 10:46 pm

        You must account for bioavailability. 0.3mg is IM. That’s got a lot more bioavailability than sublingual. Sublingual bioavailability reports vary, but Wikipedia lists 55%. So, that’s a little over 1mg absorbed for every 2mg strip. Still, that’s twice the anelgesic dose given to opiod naive patients.

      • Posted by db312 on March 27, 2013 at 10:47 pm

        And as I state above, it has more to do with dosage than %. The drop from 16mg to 8mg is 50% and few feel it. The drop from 8mg to 4mg is also 50%, and only some feel it. Most everyone drops by % throughout the process. I’m not sure where this started.. but it’s much more to do with the ceiling and self-antagonism of Buprenorphine at moderately high doses (relatively speaking).

      • Posted by Susan on March 27, 2013 at 11:28 pm

        I am very grateful to all of you who responded to my post. Your insight is invaluable to me. I want so much to end my Suboxone use. At the same time, I’ve been struggling with depression for 25 years and I am worried that perhaps Suboxone has been supporting my mood without me even realizing it. What will happen when I quit?
        The taper discussion is confusing. I know buprenorphine is super strong but it is not a full agonist and not very bioavailable. I guess your point is that I jumped from 8 to 4 mg with ease because at these “high” doses I have been way beyond the plateau of effectiveness anyway. Essentially, you are saying that one really doesn’t start to truly taper down until one is dosing at 2 or 3 mg. Is that right?
        I really hope you are wrong but, so far, my experience is consistent with your perspective. Today my doctor told me to stay on 2mg for 2 weeks and that then we will go to 1 mg-2 mg every other day. If you have suggestions for a better taper protocol, please tell me.

      • Posted by Susan on March 27, 2013 at 11:35 pm

        Benjamin,
        Thank you so much for taking the time to fill me in on what to expect. I am grateful that you are willing to share your experience so that I may benefit! I am at 2 mg and hanging at that dose for 2 weeks (so ordered my doc today).
        Best,
        Susan

      • Posted by db312 on March 28, 2013 at 12:28 am

        You got it Susan. Based on my experience, and what I’ve read, I would say that your doctor’s schedule is far too aggressive, but you’ll be able to determine that for sure when the time comes.

        One of the largest problems with Buprenorphine is that many doctors continue to be under the delusion that it is easy to jump off of once you get down to about 2mg. More doctors have gradually learned this isn’t so, but many seem to not want to believe that Buprenorphine is difficult to get off of. It also may have something do with the drug’s extremely unique pharamacological profile. There are not many drugs that exhibit a dose-response curve as odd as Burprenorphine’s!

        You can search online and you’ll find countless forums where the ‘experts’ (those who’ve been on it for years) will instruct you on tapering. As I said, they all recommend going to 0.25mg or below and they all stretch the taper out over a very long time! Some people can do it faster, some can jump from higher up. Well, anyone can I suppose, but the level of the WDs you’ll have will be proportionate.

        There are a few methods to dose at such low levels. The other poster recommended a 10-20% drop per dose plateau. Once you get below 2mg, it’s very difficult to dose at that level! One solution is to dissolve strips in water in an oral syringe, kept in the fridge. You can then squirt a controlled dose of water under your tongue daily. This seems to be the most preferred method. Some can manage cutting the strips into tiny little pieces, but I never have been able to (of course, I’m tapering using big ‘ole 8mgs :o).

        Once you do get off, you will be ‘down’ for at least a month, unless you taper farther than I have in the past and have an easier time. The WDs are extremely lengthy, much more so than opiates with lesser half-lives. It can take a week for the WDs to even peak!

        The good news? I found, the first time I got off them (back on now), that I was in touch with my ‘soul’ after I got off them. I nearly had a spiritual awakening. It’s amazing to FEEL things again. You really must be clean off them to experience what I mean, but it is truly wonderful, and you’ll find sobriety almost euphoric, AFTER you get through the hell of WDs :o.

      • So many patients say the same thing…the last few milligrams are the hardest. I’m assuming in those patients, nearly all their opioid receptors are occupied by buprenorphine even at very low doses. (But this is not the case for other patients…I’ve heard a variety of experiences from patients tapering)
        I’ve asked the drug rep several times to tell REckitt Benckiser to release a .5mg film. I think that might help the patients who feel OK at 1-2mg but have withdrawal with any drop from this.
        This is the first time I’ve read about dissolviing the film and using a few drops per day. It’s an interesting idea but of course difficult to quantify the actual amount per drop. I can’t recommend it since we don’t really know how it works. But if anyone else has used this method, I be interested to hear.

        But if you haven’t done the work of counseling on relapse prevention, consider waiting on further taper. Like any other opioid, the issue isn’t just about getting off, but staying off. Since the 1950’s, when opioid addicts were jailed just for being addicts, we’ve known the relapse rates are high even with long periods of abstinence.
        The three biggest triggers are: some medical problem arising that requires opioids; being around people who are using; strong negative emotion. You need to have plans in place to manage all these possible events, because chances are good all three will happen at some point.

      • Posted by Susan on March 28, 2013 at 8:14 pm

        Thank you all VERY much! I am so grateful to you for taking the time to respond to my questions and for your encouragement.

        I know one can always do more but I think I have relapse prevention covered. I just completed an entire year off from work for the sole purpose of engaging in intense therapy. I know exactly why I used and have removed the cause from my life. Once I did that, my cravings disappeared. In fact, my psychiatrist knew just by seeing my face that I made the change that I needed to. I walked into his office and he said, “Ah, Susan, you are no longer seeing your ____”. I said, “But you didn’t know that”. He said, “Oh, you didn’t need to tell me. I can see it”. I thought, wow, I guess I should’ve done this a long time ago!

        Thanks again to everyone!
        Susan

      • Posted by db312 on March 28, 2013 at 4:51 pm

        You’re right that the Bupe-water may not be uniform, though given that oral syringes don’t ‘sit up’ well, and thus tend to roll around, they are probably fairly well mixed. Most who recommend this method do suggest to shake the syringe before dosing.

        Even if there is variation in doses, it’s probably no worse than the current variable bioavailability of sublingual strips.

        (personal stuff)
        You’re right about the counseling and relapse prevention for sure. Myself, I’ve reached the point that after so many years of experimentation trying to ‘tweak’ my mind, I can no longer deal with almost any psychoactive substance. Even buprenorphine, when I take too much, causes a temporary pyschosis that I can barely stand. I really feel like I’m hanging on to sanity by a thread. I tried to see a psychiatrist last year, but of course was shunned as an addict. The less drugs I have in my system, the better off I seem to be. I hope I’m able to taper on off Suboxone in time. I’m at least moving in the right direction, all be it slowly.

      • Posted by Benjamin Keith Phelps on March 29, 2013 at 10:04 am

        @db312, with ALL due respect, I must disagree w/1 thing you said: I do NOT believe for a second, since I’ve been tapered all the way down to zero from methadone more times than once (I’m back on now for several years), that you NEED to be off medication-assisted treatment (MAT) in order to have any kind of spiritual awakening or to “feel anything”. You almost went so far as to suggest that so-called “sobriety” (I quote that b/c I usually consider sobriety to be connected to alcohol rather than drugs, for which I use the term “clean”) isn’t possible while still in MAT. Now I understand that you may (or may not) believe that for yourself. You are certainly entitled to have either opinion, & to express it as such. However, statements such as that can lead MAT patients to feel like they’ve somehow failed or are a failure, or that they’re somehow “less than” people in NA or AA or the likes, who are recovering via abstinence, which may not even be POSSIBLE for some opioid addicts. Thus far, it’s not been possible for me to recover w/o the use of methadone as a tool to assist. But no matter – I don’t say this to cop out & make myself feel better about being in MAT – I say this b/c Susan & others in Suboxone or methadone treatment are EVERY BIT as in recovery if they are using their meds properly (as prescribed) as anyone in meetings or any other form of recovery that is abstinence-based. Needing medication to recover from a disease, no matter which disease it may be, is not a bad thing, or a negative thing, or something to feel bad, guilty, or ashamed about. It does NOT indicate failure. It does NOT indicate weakness. What it DOES indicate is that there is a serious disease going on here & that the patient is doing WHAT IS NECESSARY FOR HIMSELF/HERSELF in order to get better, no matter what it takes! I say “BRAVO!!!” Many a person has died in their disease b/c of the shame or guilt over needing MAT, when they shouldn’t have given it a 2nd thought. I will stay on methadone for the rest of my LIFE before I’ll live my life by white-knuckling through every waking minute of every day, constantly fighting opioid cravings that are making me crazy (though I hope I don’t have to…) But let me be clear: I don’t say that I hope it’s not necessary for me not to need MAT for the rest of my life b/c anybody else thinks I shouldn’t need it or be on it; I say it b/c I’d rather not deal w/the red tape around MAT for the rest of my days & b/c I’d rather not need a medicine if I don’t have to. I mean, come on… I’d rather not need or have to pay for my Nexium for the rest of my life, too! But since that’s unlikely to be the case, b/c GERD is chronic in most cases, I’m not going to feel guilty or ashamed over needing to take it. And that white-knuckling I spoke of above that make me crazy when I’m not on MAT – that’s EXACTLY what my life is like w/o it – CRAZY! I’ve been clean of all substances including methadone for up to 2 years & 7 months (in prison), & never did get back to feeling “normal”. I still craved constantly, I still schemed to get drugs despite attending treatment in prison & trying my hardest not to entertain those thoughts, & I relapsed w/in 1 month of getting out, despite being on probation & knowing it could send me back to prison. That’s NO LIFE. I won’t live that way. Upon getting in MMT, I fixed my credit back to being perfect; I went to college (I had put that off from 1992 to 2004); I got my own place once again, which I’ve lived in for 10 years this coming November w/o any eviction notices b/c of spending rent money on drugs; I got & held a permanent full-time job at Walmart, & get this: I was promoted there to working in the PHARMACY by the head pharmacist (I’ve always enjoyed pharmacology & studying medicine – & I don’t mean just controlled substances or methadone or whatever), who knew my history b/c I was 100% honest w/him – but he saw what a hard worker I was, & he knew I was in MMT & doing well for a couple of years at that point, & he trusted me when I told him that before I’d steal any medication & get walked out in handcuffs, I’d tell him & get myself out of the pharmacy if I felt the slightest desire to do anything underhanded. And I never did do anything to get myself into trouble. I left the pharmacy about a little over a year later to be promoted into customer service management. Life isn’t perfect by far, but what I CAN say is this: Yes, I get up & take a dose of medicine in the morning everyday – just like I do w/Nexium to control my heartburn – which if I don’t take, I’ll get sick w/severe heartburn, just like skipping methadone will cause me to relapse w/my disease &/or get sick. But they’re no different – both are drugs to help me w/diseases I have – opioid dependency & GERD. And I take both as prescribed, once daily, feel nothing from them, & go about my day w/o thinking, talking, & worrying about using, buying, selling, or craving drugs & w/o thinking, talking, & worrying about severe heartburn bothering me all day. So my point in saying ALL of this is this:

        To EVERYONE OUT THERE ON MAT: You are NOT a failure for needing medication to help you stay clean. You are NOT doing anything you need to or should in ANY way feel guilty or ashamed about. You ARE doing a WONDERFUL thing – doing what it takes FOR YOU to stay clean & live as normal a life as is possible, considering the chronic disease of addiction that you are burdened with! GOOD FOR YOU ALL! If you elect to taper for YOUR OWN reasons (not b/c of anyone else – & that’s VERY important!!), then do so, by all means. But do it at your OWN pace, & for goodness sake, STOP TAPERING if you begin to feel uncomfortable, begin craving, have a relapse, or just in ANY way start to feel doubtful or uneasy about your taper &/or recovery. If you need to taper over 10 years, that’s OK!! If that means the difference between you succeeding 100% at your taper or you relapsing & ending up on illicit drugs again (even if it’s just a couple of times), then you’ve done the RIGHT thing to take that long. A single relapse can mean the death of you, or an infection from injecting that causes the loss of a limb or endocarditis (heart infection), or any number of things you don’t want any part of. And last of all: IF you decide to taper from MAT, be SURE it’s not b/c you are under the false impression that being in MAT is a negative thing. Though there are unfortunately many people who will inevitably treat you as such, MAT is a very positive thing… b/c it gives life back to those who use it as it’s meant to be used & work it the way it’s supposed to be worked. Yes, some misuse it, some sell their meds, & some don’t care anything about really getting clean. But let that be THEIR problem. If you’re doing what you’re supposed to, then you’re doing something truly great for yourself & those who care about you – & even society in general.

        @db312 – I’m not suggesting that you think this way or that – b/c I don’t honestly know your thought process. But I did want to touch on these thoughts I wanted to share, b/c after reading your response, it made me think about this stuff. If you didn’t mean it that way, that’s ok… A little support is always a good thing for those who will read this reply I gave. But if you did mean it that way, I hope you will give these things some thought, again with all due respect.

      • Posted by db312 on March 29, 2013 at 5:24 pm

        Wow! You took what I said and expanded its scope to include things I certainly didn’t say, intend, or even allude to. You seem to realize this later.

        Maintenance therapy surely saved my life. I’m still on opiod maintenance. I am in no way dissing maintenance therapy. I am not out to make anyone feel guilty, or feel pressure to get off anything.

        Susan was expressing *her desire* to taper off Suboxone. I didn’t tell her to taper off. Given that she feels confident enough to take this step, I felt it important to report my *personal experience*, hopefully giving her something to look forward to.

        Getting off opiods isn’t for everyone. There’s nothing wrong with being on maintenance therapy. However, I think freeing oneself from opiod dependence is a noble goal not to be extinguished.

        If you don’t want to get off opiods, that’s fine. It’s ALSO FINE if you DO want to get off them!

      • Posted by Benjamin Keith Phelps on March 29, 2013 at 7:03 pm

        Absolutely IS fine either way – but don’t take what I said as meaning I thought you were dissing maintenance or suggesting that Susan go in either direction – I merely wanted to be sure that she KNOWS that she doesn’t NEED to come off for any other reason than that she so desires. Believe me, I’ve been & have seen MANY others be pressured to come off quickly (before I was or they were ready), & that’s NOT a noble thing to do to someone. So I wanted to give her some support & let her know that it’s ok to remain in MAT, if she’s considering the taper for any reason OTHER than her own wishes. And in addition, I wanted to be sure her wishes aren’t based in false hopes that only 1 thing was responsible for her drug use. I hope that her removal of ____ from her life (as she described) actually WILL free her of the desire to ever use again – but unfortunately, it’s unlikely. Not to dissuade or discourage, but it’s the sad truth of addiction, most of the time. She may be one of the few exceptions – if so, GREAT!!! (And I’m jealous!!) But I hope she’s given much thought to this & been brutally honest with herself in looking at the situation. I kidded myself into believing such a thing back in my initial days of addiction, & I regret it with all my heart every day that I live now.

  10. Posted by Tom on April 18, 2013 at 2:23 pm

    I was on 8 mg film for two weeks. Didnt like the side effects so II started taperi g this week. Went from 8 to 4 to 2 to 1 in 3 nights. When would you suggest that i jump? Thanks Tom

    Reply

    • I suggest you follow your doctors directions. Getting off opioids isn’t the same thing as treatment for addiction, though it is a first step.

      Reply

    • Posted by db312 on April 21, 2013 at 4:00 am

      Yea, you better slow down. When I was told similar advice years ago, I scoffed at it. Too bad I didn’t listen. You may also come to realize that you need Suboxone more than you think. The long half life can play tricks with your mind, as you think “Heck, I don’t need this stuff!”, but then a week later, you wake up to an entirely different reality. In 3 nights, you haven’t tapered as low as you think, as the prior two weeks of 8mg is still with you. The half life can be 48 hours for some people, 24 for others, a good 36 hour mean regardless. That means it takes, on average, 1.5 days to get half of it out of your system. Do the math on that, every day for two weeks it would keep building up in your system!

      Reply

      • someone who finally understands the half life! people truly think that in 36-72 hours its all out of your system. NO. you’re right about the half life is different for everyone, their metabolism, etc. I have a pretty high metabolism, active , etc. Some people say they don’t start feeling withdrawal for 3 days. no matter what dose I’ve been on if i go about 12hrs without or miss a dose i start to feel the withdrawals kicking in (body aches, yawning, watery eyes) that will help me when coming off since its leaving me faster than most. truly crazy though, if you do the calculations it could take almost a month or more depending on the person to be out of their system if they jump at 8mg. I’m sorry I dont believe being on suboxone as being clean, you’re legal to the government. we are all still dependent on a chemical. there is a reason why they make this drug so nasty. our money goes to them instead of the streets since its extremely hard to get off.

      • Posted by Benjamin K. Phelps on July 24, 2013 at 1:26 pm

        @Ashly46, what do you mean “There is a reason they make this drug so nasty”? They don’t “make” it nasty… Buprenorphine is what it is. We either elect to use it or we don’t. It’s not like they manipulate the drug to make it harder or easier to get off of, or to make w/d’s worse or better… There are MANY drugs, analogues of drugs, derivatives of drugs & plants, etc that have opioid effects. The doctors & scientists/researchers merely select the ones that seem to have the properties (i.e. – long half-life for once-daily dosing or less, low incidence of intoxication, slow onset, & a few other properties) that make them more ideal for maintenance, do the trials on patients, & seek approval to give us options for treatment other than just abstinence or methadone. That we even got buprenorphine added to our list of options (which was previously inpatient, outpatient abstinence-based, or methadone for YEARS) was amazing. There’s ALMOST NO money in studying a medication for addiction treatment, b/c these drugs have been around MANY MANY years, meaning there’s little in the way of patents to be gotten for them, other than short-term particular-use patents or combination patents, such as was the case w/Suboxone. But they didn’t get the full-length patent that a new drug gets, therefore, they would have a much more difficult time getting back invested money than if it were a brand-new drug. Plus, money is often an issue for addicts coming into treatment, & many patients need Medicaid to pay for their meds, at least going in (though many of us can’t get it). No money is paid on days you get takehomes. Clinics only get reimbursement, from my understanding, on the days you present to the window for dosing. I don’t know how they repay buprenorphine in clinic settings versus at the doc’s office, but either way, it’s expensive medication, & many of us can’t afford it if we’re self-pay. Did I misinterpret your comment, or were you actually saying you think/thought that they really do make these medicines so that they’re difficult to get off of in an attempt to make more money? If that’s the case, it would be done on the marketing side, not the drug-making side. Marketing has often gotten into trouble, as w/OxyContin/PurduePharma, for aggressive marketing & fibbing when it comes to how safe the drug is, or how long one can be on it w/o getting into problems, such as dependence. Addiction is totally separate from dependence, so you can’t even put a time w/addiction at all, b/c you can become addicted w/a couple of uses, mentally. But physical dependence takes a set amount of time, which may vary from person to person. In other words, you CANNOT become physically dependent on methadone or heroin in 1 or 2 uses. But you CAN become addicted in the mental sense & begin doing all types of bad things to get your drug. Anyway, just sayin – they don’t “make” these drugs so nasty… There merely market some aggressively & make old drugs available to us. Clinics & docs are sometimes not quick to support a patient that wants off, but that’s a different matter.

    • Posted by Susan on April 21, 2013 at 5:35 pm

      I assume you were on a higher dose for a long period of time (a year or so)? If so, and you are doing just as well on 1 mg as you were on 8 mg, I would say go for it.

      Reply

  11. Posted by Jimmie on May 3, 2013 at 1:57 pm

    I commend the doctor and anyone who speak to this subject and continue the research we need for better methods. The brain is complicated and doctors and scientists continue to discover more receptors that were not previously known.

    I have been on various pain meds for over 17 years now. Most recent with methadone and dilaudid for pain management and now 1.5 years of suboxone/subutex. I started subutex after being abruptly taken off of methadone due to a medical condition and started taking the subutex for pain off label. I have tried many times to taper down all the way to .5mg/day and still suffer extreme withdrawals. Recently I read an article where a pain doctor was explaining that his method of taper was to continuously monitor the bioavailability of buprenorphine in the patient. His object was to keep it at a steady down state to the effect of keeping the patient out of withdrawal yet still taper at a slow pase. I personally have yet to discover a system that actually works. I realize that it’s not going to be a walk in the park but there has to be a way of keeping wd patients out of bed and moving like normal while in withdrawal.

    Keeping all this in mind, I look back and wonder if we are just being kept on this for too long. I wonder if it would have been easier, for example when I stopped methadone, was to use the subutex I was taking, to take just enough in small doses to curb the withdrawal and only long enough to get through the period.

    Oh, back to the doctor mentioned above. His method is while tapering. Rather than skipping a day before your next dose, he instructs his patients to swallow their full dose on their skip day. What this does is it still passes buprenorphine to the system but at a much lower absorption rate. Looking at his data it makes perfect sense. Since bupe’s absorption rate is roughly 10% in the gut, by swallowing the dose every other day during the taper process helps to keep the bioavailability at a steady down state.

    For the life of me I cannot find the article but will post if I do.

    Any thoughts/opinions on this? I think I’m actually going to try it and see how it goes once I am towards the end.

    Reply

    • Swallowing the medication is an interesting idea.
      And regarding tapering off maintenance medications – remember that opioid addicts in jail for months often relapse not because they are still in withdrawal but because they still have the psychological cravings. Stopping is only the first part – staying stopped is just as important, and if you are going off maintenance meds please make sure you’ve had relapse prevention counseling and/or other recovery program in place.

      Reply

  12. Posted by Denise D. on May 5, 2013 at 1:06 pm

    I’m a methadone and Suboxone-dispensing pharmacist. Maybe there’s this one paper that suggests a prolonged taper isn’t necessary, but meta-analyses of Suboxone for opioid dependence found that shorter tapers were consistent with greater relapse rates. That said, generalizing isn’t so good – you need to take into account patient-specific behaviours for a more refractory course of addiction recovery, such as harmful behaviours like needle use, the abuse of pharmaceuticals exclusively versus heroin, the length of time the person has been abusing opioids, the amount they abuse, what psych-social supports they have, concurrent psychiatric disorders and suchlike.

    And if your pt is down to 1 mg every 2 days, maybe a further decrease to zero can be suggested; that’s what I suggest to my pts. Unlike methadone, Suboxone is sort of self-tapering due to its irreversible binding to the mu receptor resulting in a long duration of action, and its partial agonist-antagonist profile. But I wouldn’t recommend to my pts that they cold turkey from 8 mg. You have to keep in mind that even though they may not have the same degree of acute WD symptoms as methadone or your short-acting mu agonists, but the WD syndrome has milder symptoms (anxiety, sleep disorders, depression) that can last for months, probably because of neuroadaptation.

    Reply

    • Thanks. I the this article wasn’t looking at success on or off sbuprenorphine, just at intensity of withdrawal. As you say, shorter tapers give higher relapse rates.

      Reply

    • Posted by db312 on May 5, 2013 at 5:00 pm

      You’re right. Generalizing is a great evil in society at large. It goes hand in hand stereotyping. I had no idea about that buprenorphine was has Irreversible binding to the mu receptor. What I really worry about is the degree to which buprenorphine causes up-regulation of opiod receptors. I assume that receptor sub-types aren’t up or down regulated to any large degree, but I don’t know that for sure, and perhaps they are. It seems that any psychoactive drug has profound and sustained neurological effects, and that’s scary.

      Reply

      • Posted by db312 on May 5, 2013 at 5:03 pm

        (update) it seems that opiod receptor sub-types/sub-units are up regulated, http://www.ncbi.nlm.nih.gov/pubmed/8393519

      • Posted by db312 on May 5, 2013 at 5:20 pm

        Rather down-regulated. Up-regulated in some cases. Anyway, that’s freaking scary. The adaptability of the body is amazing. That shows why a slow taper is so darn essential. Besides avoiding acute withdrawal syndrone, one can lose their freaking minds during the process.

  13. Absolutely a genius way to taper than, get off, Well said! !

    Reply

  14. Posted by Ashley on June 21, 2013 at 11:14 pm

    I just switched from methadone to suboxone strips and and I have begun to tapper myself down n I was only on 30mg of meth and took a 1/3 piece of the strip 3 days after stopping meth. So now I’m taking 1/3 of the strip a day and I’m ok and answer me going to continue to tapper down but my worry is that when I’m done with the suboxone, will I still feel my body yucky from being on the meth since 2008? Or do you think I will have everything out of my system?

    Reply

    • I don’t think anyone can answer that question for sure. People are different. Some people would feel significant withdrawal in the situation you describe. But getting off methadone/suboxone is only the first part. the most important is STAYING off all opioids. I hope you are following a doctor’s instruction on this taper??

      Reply

      • Dr Burson/ This study is wrong! I have been on subutex 8mg for 5 years at unethical doses. Was started out @24mg on the first day of treatment for abusing 20 hydrocodone 10mg for 6 months!!!!

        I also have taken 60 mg of subutex 8mg per day! The dr told me I had built a tolerence and allowed this, no illegal crap. No dr hopping….etc

        As u know I was at 6 1/2 subutex 8mg at the end of may!

        Then I jumped to 5 per day! June 1,2013. I have had a headache since then till today.

        June 26 I jumped from 5-4 (8mg per day)

        So I have made it on 32 mg subutex for 6 days now! Yay! As I have not been this low in over 3 years!

        Here is reality: minus the extreme headache for the entire mo of June – I was fine up until today! Day 6 of weaning to 4/day. So this study is bull!

        According to studies on ceiling affects – I am not suppose to be able to tell a difference between 4 or 7, and I actually agree that 32mg does occupy the brain fully. However:

        I am currently sad (deeply) and didn’t realize what all the subutex was covering up- emotionally. Apparently it’s great for sadness! I fear more.

        I feel like something is on my chest and shoulders and GI upset just began. Day 6.

        My pupils began jumping side to side yesterday and I am extremely sensitive to light now, and sound. My eyes were not twitching – as in eye lids/ it was actual pupils. I have never experienced this before. Ever!

        No appetite started today

        Extreme heartburn past 6 days. – I never had heartburn – ever

        Uncontrollable cold shaking and teeth chattering started today (even outside).

        Have broke 4 teeth from grinding the past month.

        I am at 32 mg! Which is normally the super high dose anyone in treatment receives! All I have done is jumped from 6 1/2- 4. And according to ceiling affect- I shouldn’t be in any withdraw so I reckon it’s all mental. I don’t know doctor but I was fine till day 6, and I (unfortunately) may be the highest dosed patient on Roxane subutex SL you have ever encountered.

        I must state I have never done any illegal drugs, snorted or injected subs, as I have read people do. I really did take it SL the whole 5 years. Just at crazy large doses the last 3 years. Never relapsed to hydro. Never failed drug test in 5 years.

        The new dr stated last tues “I have never seen this in 4 different states “referring to such a large dose. Lol – ok not funny.

        So I just wanted to share my experience with you as I know you love research!

        I will also state: the first time I tried quitting subutex at 24mg/ day after 18 months of treatment. I was fine! No withdrawals at all! NOT UNTIL day 14!!!! The day I went crazy (with worst withdrawals ever) and I relapsed back onto subutex- then it was a steady up climb to large doses which is where I am at now.

        *but for me- I didn’t have not one problem quitting at 24/mg at all- then day 14 humbled me and I remembering crying whole way to memphis! I thought I was over it and that I made it….why day 14!? I will never know!

        But I do know that study is inaccurate! I don’t know if this helps with your research but I hope so.

        Thanks and God Bless, ! Nacole

  15. Posted by ash tray on July 17, 2013 at 10:41 pm

    ive did a 4mg every 6hrs then to every 12 thenwent to 2mg in mourning 2mg at night then went 2mg a day then nothing total of 7 days and been good ever since so far maybe this taper may work for you

    Reply

  16. Posted by Lesly Martins on July 22, 2013 at 5:18 am

    In my part of the world (South Africa) patients have always gradually tapered down.
    Minimal withdrawal symptoms were experienced.
    Buprenorphine/nalaxone (Subuxone) have always been preferred above the mono product(subutex) as it is the safer option.

    Reply

  17. LOLLLL at jumping at a higher dose makes you better off! that is why people are in withdrawal for months, you know the horror stories you read online? they’re not joking. tapering doesn’t prevent withdrawal it shortens it by a lot if you can get down to a moderately low dose. remember you didn’t get here over night, you won’t get out of it over night. I always thought that half life meant in 72(ish) hrs and it was ALL out of your system. Wrong! if you jump at 8mg in 3 days 4mg is left in your system, another 3 days 2mg is left in your system. at 8mg it would take about 3-4weeks for it to be completely out of your body. I really don’t think people understand this. those people in the survey were not fine in 4 days, I don’t care what they say. I’ve researched and talked to people doing it. the only ones who weren’t in pain for a month+ are the ones who tapered slowly to a low dose. I’ve been on it for 5+ years. 2 of those years i was buying it off the street before i went to a doctor for help. During that I was only taking about ~1mg a day and came off it twice. I was okay in a week in a half and it was only so short because of the small dose. I always went back because the depression after. I’m tapering now and planning my last and finale jump. Do not jump at a high dose unless you’re prepared for months of drag out pain. you can go into it cocky and with no plan, but it’ll break you of that fast. I like the taper plan above. My doctor refuses to help me taper so im on my own. Getting my money is too important to him.

    Reply

  18. Posted by Bad Egg on August 22, 2013 at 11:46 pm

    I have been on Suboxone for a number of years. My doctor has me on 3mg (1-1/2 strips), but I have comfortably tapered to 2 mg for quite a while, keeping some “in reserve”. Now I am 9 days into my next step at 1.5 mg. and feeling pretty good. I plan on staying at 1.5mg. for another 21 days, then tapering to 1 mg and see how I feel. If I find that too difficult, I may go 1.5, 1.5,1 and repeat for another month, then 1,1, 1.5 and repeat another month. I’m hoping slow and steady may do it. A HUGE part of it is mental. When I have misplaced it, I get in a panic, even though I have dosed recently and there is NO WAY I could be feeling any w/d symptoms. Pray for me. I want off.

    Reply

  19. Posted by Michael on September 4, 2013 at 11:42 am

    I discontinued Suboxone after two years of use. I tapered from 16mg to 8mg but hit the wall with the taper. I finally became desperate and just quit taking them. The withdrawals were two of the worst weeks I’ve ever experienced. Tremendous RLS the first week, 4 hours of sleep in 5 days the first week, extreme fatigue that slowly improved over four weeks and general pain for weeks.

    I personally think the marathon nature of Suboxone withdrawal contributes to the overall suffering and may not be measured in the studies. I’ve detoxed off Vicodin several times and I know that after three or four days of intense suffering I’ll be OK. With Suboxone, the withdrawal symptoms are somewhat indefinite and really take a physical and psychological toll over time.

    The only way I was able to succeed was by taking time off work and completely resigning myself to suffering (not that I didn’t try exercise, vitamins, etc. when possible).

    Reply

    • Posted by arod227 on November 13, 2013 at 12:34 pm

      This is the most effective way is to gradually decrease your dose every two weeks…or longer if you need it. When you get down to .25 ..you might need to take it a month or so before you start skipping days. Make sure your mentally ready to take this next step. Start skipping every other day…for 2-3 weeks…then skip 3 days for 2-3 weeks…then skip 4 days for 2-3 weeks…This allows the half life To break down & also allows you to live your life without taking something everyday. Now..everyone’s different. If you start to feel.discomfort don’t run to grab a small.piece of sub..Instead take some ibuprofen. If it gets really bad…then obviously take a small..25 piece. Just remember ..never go back up on your dose. .25 is such a small amt & with skipping days ..it’s kind of your security system. Eventually… you ll forget to dose… and you ll be done with it forever! Good luck & god bless!

      Reply

  20. Posted by Shawn Jetton on February 7, 2014 at 5:43 am

    I was on 20 mg of suboxone per day. I reduced 1 mg every 2 weeks until I was down to 4 mg then I reduced one mg per month. when I was down to 1 mg for a month I then reduced that to .5mg for a month and then .25mg for a month. it was a little difficult to cut the 8mg strips into .25mg but it was doable if I cut them diagonal from corner to corner. when I finished my month at .25mg it was time to stop taking. I was scared about another hell withdrawal. I was surprised I had no with drawl except on day 3 and day 5 I had a couple hours of weirdness and thought I was about to start that crazy withdrawal we all hate but it went away in a couple hours both days. I took the last .25mg on jan 4th 2014 and I feel great. I feel way better then when I was on the sub. finally free and if u wean off slow as I did I think people can stop without no or much withdrawal.

    Reply

    • Posted by Benjamin K. Phelps on April 20, 2014 at 3:06 pm

      Shawn, if you are able to STAY stopped from the opioid drug use now that you’re off, & you feel normal/good/great/free now that you no longer take any bupe, I AM ELATED FOR YOU!!!! And SOOO jealous! I wish to goodness I could come off methadone & feel normal & not crave 25/8 (in other words, all day, every day), but I’ve been all the way off, came down REALLY slowly, & I did fine with the taper & withdrawal levels – no w/d’s at all, in fact. But I started seeing old behaviors popping up everywhere… Looking at pics of controlled substance pills online like they were in a Christmas Wishbook from Sears for a couple of hours before stopping & thinking about what I’d been doing. I hadn’t done that in years at that point, so it bothered me to catch myself doing it again. I caught myself entertaining thoughts of schemes to get hold of opioids w/o anyone knowing, etc, etc, & I just knew very quickly that I was not ready to be totally off. To that end, I waited just a few days to be sure that it would not settle down some if given time, & when it didn’t, I RAN back to the clinic & got on as quick as I could. I’m still not ready – I know this b/c of my current stress level. But I hope to be able to come all the way off & GET AWAY FROM THE CLINIC SYSTEM one day soon in my life!! I’m so burned out from false positive screens, call backs, dosing hours, dosing lines, holiday hours, getting an increase, getting a decrease, remembering to bring back empty takehome bottles (or losing all my takehomes), cherry syrup that can spill (& if it does, hate it for ya bad luck!), treatment plans, different docs w/different policies at the same clinic (which can mean you’re kept on – merely as an example – benzos for 6 years – then the next doc walks in & doesn’t believe in benzos & DEMANDS you stop taking them THAT MOMENT… no taper or help in any way & sends you to a private doc on your dime to get the ones you need to taper if s/he lets you taper – this was done to me with Lunesta, though it’s not an actual benzo but does work on the benzo receptors). It’s just been a HELLISH experience that I wouldn’t wish on ANYBODY. The treatment geared toward helping me have a normal life w/o the stress of addiction has been the CAUSE of more stress in my life than any other single thing in my entire life. I’ve had takehomes taken away from me over false positives that I finally found were the error of the clinic itself after a month of proclaiming my innocence & offering hair & to pay the clinic’s choice of a lab to test that hair against the supposed substance to prove my innocence, but they wouldn’t allow it (naturally!). Last year, I had a false marijuana positive I wasn’t told about until over a month after it came back! Then they tell me it’s too late to challenge, so I just have to lose takehomes & EAT THE POSITIVE being put in my record (accept it)! Well, I bitched & moaned about this – they should’ve told me IMMEDIATELY upon return of a positive result, when they knew I have NEVER done marijuana in my entire treatment life! I hate marijuana w/a passion. Anyway, the doc finally did a minute’s research after a day where I particularly got passionate about it, & found that…. get ready for it… There was NO SUCH POSITIVE IN EXISTENCE & nobody could determine why it had been entered into my file or into my computer profile, leading me to lose takehomes! THIS IS A PROBLEM when you turn someone’s life upside down & the thing you accuse them of doesn’t even EXIST!?!?!? Now this past month, I got a false cocaine positive at my new clinic. They took a single takehome, per policy. But they told me too late for me to challenge, despite me having the money to do so. I made noise, to no avail. I tried to get to the program director but was sort of told he had already said this was how it was gonna be. AND ON TOP of losing the takehome, I was 2 months away from my next TH. So I lost that whole 6 months of clean time towards that next takehome! So I finally managed to get into the program director’s office one day w/o asking my counselor first, & she was called in to meet us there. I stated my case, & lo & behold, THE DIRECTOR HAD MISUNDERSTOOD, & after ALL THAT anxiety, stress, anger, hurt, etc, he GAVE BACK my takehome, & so now I’m still about to get my 6th takehome around the 1st of June. But see how easily a miscommunication can ruin someone else’s life? I drive half an hour each way & have ZERO income right now, & then my meds are $14/day!!! I get food stamps, but I’ve had to beg friends for help while looking for work. I just got & started a new job, but am in training, so I don’t get tips just yet. But my point, albeit long, there’s STILL WAY too much miscommunicating, false positives not given any critical thought – the doc/counselor should be looking at the patients’ history & behavior when there’s adamant denial, but MOST OF ALL & FIRST/FOREMOST, TELL US IN TIME SO WE CAN CHALLENGE!!! Most people won’t spend the $50 if they’re guilty b/c they won’t get it back that way. We ONLY get it back if we’re innocent of using – but that takes like 5-6 weeks (b/c we all have that kind of money lying around we can afford to wait forever to get back….) These treatment centers & staff should be ashamed of how they’re run & the way they treat patients. While at RMTC (owned by Sellatico) in Raleigh, NC (Yes, I’m calling them out), where the Lunesta thing happened to me, I had SIX (6) FALSE POSITIVE TESTS while there in 6 YEARS!! That’s 1 per year! I proved them each & every one wrong, but there, they didn’t give back any money if you exonerated yourself! I paid $55 each time to prove I hadn’t done anything. One of those 6 times was clinic error b/c they didn’t write somebody else’s ID# clearly, & it looked like my ID #, & nobody questioned it when a result came back for a guy who hadn’t even been given a test to begin with… They just entered a test & then a result for me… a POSITIVE result.. So when I challenged, it was still POSITIVE! Imagine my horror, when I’d not seen or used hydrocodone in MANY YEARS. It took me a month to finally ask for the requisition form for the test, & I found the sample was submitted on a Friday. What saved me was that I’d not been to the clinic in years on a Friday! I had 2 weeks’ takehomes at this point. So when I showed this to my counselor/program director there (1 in the same person), she gave me my money, takehomes, & EVERYTHING back. But she could not give me back the stress, anxiety, crying, praying, hoping, desperation, & racking my brain to try to figure out what the heck was happening to me & why. I got NO APOLOGY from the owner, nor anyone else. Sadly, a month later, that same owner, whom I’d asked for a simple apology for not having checked their paperwork before taking away everything I’d worked so hard for – I understand people make mistakes, I’m not perfect either… But an apology was in order – she took a fall down the stairs in her home in Northern Virginia & passed away. I don’t know if karma does play any role in our lives, & I CERTAINLY don’t think my mere situation would have warranted such hardcore karma of the negative kind… But anyway, THIS is the system I want to get away from. I’ve been stuck in it for over a decade now, & while I love my current counselor & I DO love my clinic, even with its flaws (b/c my last clinic would not have changed ANY punishment, no matter how many times you’d have shown them it was their mistake or couldn’t be helped). I.e.- my new clinic did a callback on me after I’d been there a few days (I transferred in w/5 THs.) There was never a call at my house that night. The next morning, I went to dose & was told I lost all my takehomes for at LEAST 30 days b/c I failed a callback. I have a MagicJack, & it logs EVERY CALL. It also has an online call log you can print. So I listened to my messages, & nothing. So I printed the call logs & took them in to the counselor. She still didn’t think it was going to matter, but we took them to the program director. They made me wait for a phone call that night from them (I gave them my cell number so they could ALWAYS reach me), & when they called me, they gave me EVERYTHING back, & said just that one time, they were gonna overlook this b/c of the proof I brought, & they did another callback randomly not too long after, which I passed w/flying colors, as I have every time I’ve ever done a callback at other clinics in previous years. But Southlight would not have considered the call logs, nor any other evidence that my phone had not been called. They’d have punished me, regardless of the proof that I could not POSSIBLY have known about a call back someone said they’d done. I don’t believe my counselor was lying – but somehow, whether she dialed the wrong number, or my MagicJack messed up completely, all I know is that no call was on the caller ID of the telephone, nor the computer (soft-phone on the screen), nor the internet call logs, nor the voice mail. Yet Southlight would have punished me anyway. That’s why I wanted to leave SO BAD for SO LONG. It’s a shame though that the cheapest clinics here are Southlight ($9/day), & BAART in Durham, which does NOT give you your takehomes you x-fer in with for up to 6 months, while they “get to know you”. Last I checked, they were $55/wk. Even if that’s understandable, a few weeks ago, on a Saturday or Sunday, no dosing nurse showed up, nor other staff. This is twice that I know of (& I don’t keep good track of their goings-on). NOBODY IN THAT CLINIC GOT DOSED THAT DAY!! Are you KIDDING ME???? That’s OUTRAGEOUS! You don’t leave a whole clinic of methadone patients undosed for a day for ANY reason!! There should be an emergency plan in place for such problems. At RMTC, we had a plan whereby we were to go to Southlight if directed to on the TV when it snowed or whatever & they ran announcements & they told us what channels to watch for information.
      This type of stuff should not be happening – clinics having nobody show up to dose the patients & not even bothering to fix it that day & open a little later!!! They just left every single patients w/o their medicine that day! Takehomes being taken away when the patient has not done anything & you have darn good, solid reason to believe s/he is being 100% truthful with you (the doc/counselor). And in my most recent false positive for cocaine that I wasn’t told about until it was too late to challenge, I had JUST come into my counselor’s office not a week or so before that, & sat down to tell her I’d taken a Xanax b/c being unemployed & not having the $14/day for treatment & having to beg practically, I was stressed to the MAX. I didn’t have to tell her, I didn’t know but that I wouldn’t lose half of my takehomes… I had no idea! But I wanted to be honest & tell on myself. So a week later, you’d tend to think there’s be some reason to think I might be telling the truth. And to her credit, my counselor DID say she believed me, but I was still punished. My ONLY problem w/this ENTIRE THING is that I was NOT TOLD SOON ENOUGH TO CHALLENGE IT & prove myself innocent of cocaine use. I haven’t used cocaine in about a year, when I had gone to a party out-of-town, which I also walked into my counselor’s office at Southlight & told her w/o prodding & knowing it would mean the taking of half my takehomes there. Counselors or docs – whomever is telling patients about positive drug screens at any particular clinic – SHOULD ALWAYS be telling them about ANY POSITIVE RESULT that they may challenge if it could be false. When that isn’t done, I feel the ONLY reasonable thing to do is to throw out the entire test & results completely – no putting it on file, no NOTHING. You should ONLY be documenting results of tests that a patient has had the chance to agree or disagree with, & if s/he disagrees, s/he should have every opportunity to challenge it via GC/MS. Then, AND ONLY THEN, should the results be put on file as final for that urine sample. And even then, if the patient is adamant that s/he has not used, EVERY REASONABLE STEP should be taken to try to ensure that paperwork is the right paper for the test that was both administered to the patients on testing day, & that it also is the paper that goes along w/the sample that was tested at the lab the next day or whenever. I know I have preached an entire sermon, but everybody on here knows of my passion when it comes to MAT issues.
      I am SO ECSTATIC for Shawn Jetton – Man, I hope you flourish in life & NEVER LOOK BACK!!!! As a favor to those of us still needing the help of medications to live, please don’t down-talk MAT/MMT (med-assisted/methadone maint treatment) to others, or say it was worse than the dope, or that others don’t need to stay on it any longer than you did or that some may not need it for life. Please keep in mind that every single one of us is different, & the damage done to each & every one of our bodies is different, & as such, we each need varying levels of treatment, varying doses, varying medicines (& some need no medicine), & varying levels of comprehensive treatment with the medicine, like group & 1-on-1 counseling. Just ALWAYS keep in mind that this medication helped you get from a bad place over to a seemingly very good one. That means it was a HUGE BLESSING to you! Always remember that & remember those of us who still require the use of that blessing, & especially those who will need it for life or close to it. Educate others when you can about MAT, & don’t limit it to “I got off after x months, so anybody else can too.” That’s unfortunately not the case. But BEST OF LUCK TO YOU, SHAWN!!!

      Reply

  21. Posted by Becky on March 25, 2014 at 2:46 am

    I’ve been on suboxone since March 2013 on 2 8mg strips and started being winged off in November of 2013 and am down to 3 quarters of a 8mg film and haven’t felt a change should be done in another month he wings me a quarter a month as of right now I can’t tell a difference at all, I have also been attending 3 or 4 meetings for the past year a week to help with the mental part. I think it depends on the person

    Reply

    • Posted by Susan on March 26, 2014 at 1:11 am

      Becky,
      I hope that you’re right but your story is a familiar one. Many people do not feel a thing until they get down to around 2 mg.

      I was at 12 mg last summer and decided to start weening. In a few months I was down to 4 mg–no symptoms. Then I got to 2 mg and I could not figure out why I was always feeling panicked and exhausted & jittery. Finally a friend took me aside and said honey, you are in withdrawal! She was right. I am staying at 4 mg until I feel confident to try again.

      Best of luck,
      Susan

      Reply

  22. Posted by Gary on April 7, 2014 at 6:31 pm

    I’ve been on Suboxone 8mg for about 1 year now because I got on too high of a dose of Vicodin after a car wreck. I went to detox and when I got out I stopped the Suboxone a week after being on them for 2 weeks. I felt fine for a month, no withdraws due to being on them for such a short time. I did my follow up appt. with my doctor and he convinced me to get back on them which was a mistake in my opinion because now I’m having to taper off slowly after almost a year on them daily. I can understand staying on them if I was a drug seeking addict but I followed my RX which was probably too much in the first place but I was in serious pain after the wreck. Anyways, I had a period of bad pain over the past few weeks and I was unable to get any relief due to being on Suboxone and I didn’t even try, just doubled up on Advil which didn’t work. I went from 8mg to 2mg per day in about two weeks and so far I only feel a little anxiety but I know 2mg and down may be harder but since I’ve been on for only about a year I hope it will be easier, and maybe since I was never an addict that may be in my favor. I took Vicodin for years for pain with no issues, until the car wreck. Been on Xanax for anxiety for 15 years and the last refill for 60 count .5mg was over 2 years ago, which shows how little I use it. I’m doing a taper plan listed online that takes about 3 months and goes from 2mg to .025 and ZERO.

    Reply

    • Yes, I too am curious as to why your doctor wanted you to go back on Suboxone after being off all opioids for a month – unless you were having continued pain and needed some sort of opioid to be able to function?

      Reply

  23. Posted by dusty schale on April 15, 2014 at 10:53 am

    I just wanted to post sense I’m always reading these. I am 24 yr old male. Been an addict sense college. Like a lot of u guys it was the weaker pks that got me hooked. I have been doing them daily for about 6 yrs. But the last few months have been visuous. I have been smoking fent patches daily until they are gone every month by about the 10th of each month n been smoking blues but they don’t do anything after smoking those 100 MCG gels. So finally got some subs n was wondering if anyone has actually had a cpl weeks worth to get threw main withdrawels then made it or was Able to quit. I hope I can make it:( good luck to everyone fighting this battle…..

    Reply

    • Posted by dusty schale on April 15, 2014 at 11:05 am

      FYI not prescribed tried to tho. the receptionest said would be over a month to get into an appt. Which is good I just gotta get threw this and be myself again. Been with a gf for over 4 years and i hurt her so bad with my bad habits. I am ready!!! I make about 1500$ a week and spent about 600$ a week in my habit. so I’ve saved a shit ton of money even these last 4 days on subs

      Reply

  24. Posted by foxxycat on April 30, 2014 at 7:49 pm

    hi there i have been on suboxone since 2010. i have tapered from 4 to 2. now the past 3 months taking 1.5. last week i tried one day of 1mg. i belive it was sat, today is wed and i have the flu. is it withdrawals? i have a fever since monday nite and a bad cough..this afternoon now i have GI issues..I have no appetite and cant eat. did i taper too fast? I wonder if I did catch the flu or am i having serious withdrawals? I also used to take advil pm nightly but stopped that last week..i wouldnt get withdrawals from benedryl would I? I am scared and depressed that i will never get off the subs. my next apt is tomorrow and i was ready to quit but now that i am sick..i am setting a new date of June 14. going to try again at 1.5 for 3 days, then 1 day 1.0. and if i get a fever again then this is withdrawals? I dont remember getting a fever when i tried w/d off opoids..i did get super sick…is fever a sign of withdrawals?

    thank you

    Reply

    • Fever is a sign of infection so I highly doubt it is withdrawal. I know when I taper too fast and go into WDs it is a specific set of symptoms… Leg cramps, achy joints, headache, fatigue, restlessness and GI issues, but no fever. I also thing dropping from 2mgs to 1.5 wouldn’t be enough of a drop to send you into WDs. Take your time with the taper though. 3 days at 1.5 then down to 1mg for 1 day might be too fast. In my experiences, it takes a few weeks for your body to stabilize at each lower dose. Dropping dosage before you’ve stabilized on the previous dose will cause WDs as if you just stopped cold turkey at the higher dose to begin with. Slow and steady wins the race…

      Reply

    • Posted by Illustrated Woman on May 7, 2014 at 5:06 pm

      Everyone’s withdrawal is different, but it sounds like the flu with the fever and cough, which I’ve never experienced nor has anyone I know. There’s also usually a big mental part to withdrawal so, if you only feel physically ill, you probably are.

      Reply

  25. Sub is strong, 2mg is equal to 40-60mg of Oxy. Anyone jumping from that amount who felt fine is far and few between. You need to get down to .250 or .125mg before jumping. Watch for posts from people who post 2-4 days after stopping Subs saying everything is ok. It takes about 5-7 days before you start feeling like shit. Like anything else the lower you get the better it will be. Try to wrap things up in 2-4 weeks. Longer use leads to more addiction. Get in-Get Out-Tough it Out. It takes a lot of willpower because the cravings will come roaring back when you start to feel ok. So have the desire to stop or it’s a waste of time

    Reply

  26. Posted by nick on May 22, 2014 at 5:39 pm

    Hello dr…Thank you for your post.i am a recovering heroin addict, and have been fighting this disease since 1998…I’ve tried everything from cold turkey, to na meetings, to methadone and suboxone….the first time I was on suboxone was in 2001-2002…This was before it was available to the general public, I was on a study through yale…but I was also early in my addiction, and was not serious about recovery. ..This study involved me having to go and get dosed every day as if I was on methadone. ..I was on 24mg a day…I was on that dose for about 6 months, then one day I decided that I didn’t want to have to go every day and get dosed…so I just stopped. ..and I had minimal to zero withdrawals. …I didn’t use any opiates for at least a month after my last dose….and today I am sober with the help of suboxone, I have been back on for about a month now…and I have been reading a lot of horror stories about getting off of it…and it scares me…so I’m debating stopping now because I know I don’t want to be on it the rest of my life. ..and in my own experience I had no withdrawal when stopping cold turkey after a few months….but then while on suboxone, I don’t have any cravings whatsoever and that is very important to me and also I suffer from chronic pain as I had a traumatic work related injury falling 30 ft off of a collapsed scaffolding. ..and while helping me get off of opiates, the suboxone also helps with my pain ,and being an addict I cannot safely take any other pain medication. ..so I am stuck between a rock and a hard place…I’m not sure what to do…but I just wanted to share my experience with you

    Reply

  27. Posted by Kurtis on June 17, 2014 at 2:01 am

    I was perscribed 24mg of suboxone a day and I seen a doctor in another state for it and he gave me 48 pills and told me ween off of it which was highly impossible, i ended up withdrawaling for days and it really was horrible. I ended up back on suboxone again and started off same dosage but worked my down to 1mg a day now and im on my last month and I feel like I don’t need it at all. Life is legit and im loving it. I’m medication free from all pharmaceuticals after this. Also Cannabis helps alot with withdrawal symptoms too.

    Reply

  28. Posted by thomas miller on July 16, 2014 at 6:17 am

    I have been using subs for 2 and half years and they suck, as they are very cheap only 35 dollars a month for the doctor visit and the sub films still very depressing. The funniest thing is I cant find one success story on the internet about how someone has successfully came off sub’s without very little side effect. I am down to just 1mg a day, I have made it to only day 3 before I slapped a sub in my mouth. I take sub’s for depression or at least my doc says there good for that but I started taking them in the beginning for opiate addiction then I got very depressed after losing 3 fingers and a eye my doc increases my sub which he still thinks I’m on (12mg). whenever I mention to my doctor about getting off he does everything he can to find a way to keep me on it or he says I’m not ready. has anyone ever heard of suboxone being used as an anti- depressant? The DT’s are what scare me the most and would love to hear someone’s success story how they have gotten off sub’s with little or no DT’s.

    Reply

  29. This study is interesting. I’ve wondered the same concept myself. I was on Suboxone 4 years ago for about 6 months at 16mg/day. I quit abruptly when I was unable to pay for the Dr. Appt and I felt little if any withdrawal. I was clean for 2 years then slipped up on a prescription of pain meds that turned into a year long return of my Vicodin affairs. Last year I went back on Suboxone and expected it to be a easy breezy like last time. I’ve weened down from 16mgs/day to 2mgs/day. Logic would say that 2mgs would be a walk in the park if my abrupt stoppage at 16mgs went smooth, yet I go through some pretty pronounced WDs every time I try to drop to 1mg, and the one time that I tried to stop at 2mgs a few months ago was a train wreck of acute WDs. It’s definitely an interesting concept but I’ve come to far to go back to 16mgs and start experimenting! I’m just going to keep plugging away and preparing myself to “pay the piper” because I’m hitting the point where it’s time to s*** or get off the pot. I’m convinced I can do it. Mentally I’m ready. Just afraid of these damn WDs!

    Reply

  30. Posted by Robert on September 5, 2014 at 2:54 pm

    For me personally I have never once been able to taper. And not because tapering doesnt work, because I cant manage to even taper. Im a crazy person, and even though it doesnt get me loaded I still try
    and I run out. i will get more and I do the same thing again. I will just repeat this until i eventually just get a full agonist. The only thing that has ever worked for me was just cold turkey. Last cold turkey I was very very uncomfortable for just over 30 days. It eventually passed. But i am in the same situation once again. i somehow went from being totally sober for six months to getting strung out on suboxone been taking them for three months now and am afraid to try and stop. Im so scared of withdrawal again. like why did i suffer that month of misery to kick cold turkey just to get strung out on subs. i mean who does that. I have chronic pain and that sucks because i always think i can take an opioid for my pain with it is not tolerable and everytime i try i cannot stop even though i with all my heart intend to only take it when in bad pain. it never works and i am strung out again. what do i do.

    Reply

    • You are not crazy – you have addiction, which means you have lost at least part of your ability to control your use of opioids. You don’t mention anything about seeing a doctor for your addiction. Have you done that yet?

      Reply

    • Posted by Benjamin Keith Phelps on October 19, 2014 at 11:52 pm

      Dr Burson put it slightly more politically correct, I guess you could say, than I was going to (not that I was gonna be mean, but…) You do this b/c you’re an addict. You will keep doing it b/c you’re an addict, until you accept treatment. Treatment for you may mean Suboxone, taken as prescribed in a maintenance regimen, not a taper. Or it may mean full agonist therapy, meaning methadone, again – taken as prescribed in a maintenance dose, not a taper. Evidently, like most opioid addicts, you cannot successfully taper right now. That may not mean forever, but right now, it’s a problem you cannot seem to overcome. What do you do to overcome it? You get STABLE on Suboxone or methadone, then you STAY STABLE on whichever one you’re on. Stable means CLEAN, USING THE PRESCRIBED DOSE EXACTLY, FOR AN EXTENDED PERIOD OF TIME. You don’t buy more on the street, or take your dose early – that’s not stable. In order to accomplish this, you may need a higher dose than you think. You can’t walk in & say “I won’t go higher than 4mg of Suboxone or 50mg of methadone & think you’ll be successful. This is not a numbers game. Well, then again, it kinda is – if you’re not on the right dose FOR YOUR BODY – not what I think is right or what your mom or wife or partner thinks is right – but what you & your doctor agree is adequate to quell your cravings & stave relapse, you’re going to secretly keep relapsing. You have to walk in, determined to be BRUTALLY HONEST with the doc until you are successful at getting clean. And then you have to STAY WHERE YOU ARE for a BARE MINIMUM of 1 year – that’s 1 year of stability, not 1 year of treatment altogether, & most professionals agree that 1 year is not usually enough. The longer you’re stable on maintenance, the better the odds you’ll stay clean when you slowly taper with your doc’s oversight. You don’t want to be an addict – which is perfectly fine & understandable – none of us do. But it’s what we are, & it’s what we do best. So in order to arrest that problem, we have to surrender to treatment for an extended period of time. If you indeed really do have chronic pain, then methadone is probably going to provide more relief for that, if any… though when taken once daily, methadone doesn’t exactly help much with pain (for pain, it needs to be taken in smaller, divided doses throughout each day, which clinics can’t do. At BEST, they could give you a split dose as half in the morning & half for the evening to take with you.) Suboxone, however, gives you more freedom & gives it to you faster. Methadone means clinic visits for a long time before takehome doses are possible. A regular doc cannot prescribe methadone for addiction by federal law. But Suboxone is expensive, & gets more so by dose, where methadone does not. Personally, I take methadone, & it takes me a pretty significant dose to feel satiated with my cravings. I can stay clean at 120mg/day, but I crave & battle wanting to take my takehomes early. So now I am at 160mg/day, & I suffer MUCH fewer hot flashes & cravings than at 120mg. That is no big deal, b/c until you get down to around 50mg/day, you can go really fast in the taper (at least, I can…) I have dropped 10mg twice weekly from 155mg/day down to 47.5mg/day with no problems until I got that low. Then the cravings hit hard & old behaviors started returning. I didn’t relapse – I gave it several weeks & then headed back up to avoid white-knuckling through life everyday. But that’s me. You may do fine on 60mg/day of methadone, or it could take you 250mg/day – you never know until you are on it & feeling well. Once you find your stable dose, you won’t care about going higher & higher – you’ll feel just fine & won’t crave more. Trust me – I’ve been a certified methadone advocate for 11 years now (by NAMARecovery) & I have personal experience with addiction to opioids for 8 years prior to this, & 11 years on it. I have tapered all the way off, only to return to treatment without relapse b/c I was on the verge of a relapse & I knew it. I know this battle inside out. Dr Burson knows the treatment side of it inside out. She won’t advise you wrong. I am not advising you to take methadone, nor am I advising you to take Suboxone. But I’ve tried abstinence-based treatment 6 times up to 2.5 years. Nothing took. The only way I stayed halfway clean during those times was when I was locked in a facility. The moment I was free or had access to mail or a visit, I relapsed. I never made it for long before falling on my face. Admit your illness (addiction), accept treatment, whatever it may be – I personally would tend to believe it’s time for properly prescribed maintenance, but that’s my own opinion & I’m not a medical professional, as much as I like to think otherwise. No amount of trying this different ways is going to change the outcome. If you use, you WILL become dependent all over again. So either stop dabbling, or if you honestly can’t, then get on maintenance, & get on with life. It seems like you’re toying with maintenance, but don’t want to commit. That’s only going to screw your life up worse than it already has been so far by addiction. Just my 2 cents. Hope it helps you. Best wishes.

      Reply

  31. Posted by Carol on October 17, 2014 at 1:11 am

    Hi all. I am on 8mg, beginning my 1mg taper. How did you choose to cut up the film to take one mg off? Keep dividing it in two? I would like to know the mosts precise way to do this.

    Reply

    • No one knows. The films aren’t meant to be cut, but it’s commonly done. Otherwise, the lowest dose a patient could get to is 2mg, since that’s the lowest dose of film. There have been no studies to show the medication is evenly distributed. However, with buprenorphine’s extremely long half life, blood levels probably don’t vary much if you get a little more on one day and a little less on another.
      But no one has a precise way to cut the film.

      Reply

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