Suboxone Detox and Post-Acute Withdrawal Syndrome

We seem to have opened a little tin of worms here with the posts about Suboxone, starting with my interview with Dr. Steven Scanlan, a Florida addictions specialist who uses Suboxone and Subutex to detox patients off opioids.

People are writing in about Suboxone. It’s great that folks are asking questions! I need to emphasize (this also appears in my “About” page) that I’m not an expert or practitioner. I don’t dispense professional advice; I share personal experience. I’m a person with addiction who has been through the mill. I write from the place of “beginner’s mind.” The experience of detox—choosing a method; committing to it; literally waking up and smelling the roses—is still fresh for me, and the feeling persists in my daily life of being lucky to be alive. I write this blog because I used to take so many different drugs, and had lost control, and am now able to stay sober. I know there are solutions out there, some of which don’t involve being on drugs for the rest of one’s life.

And I seriously used to think I’d just have to be on drugs for the rest of my life. I’m only 46.

So a reader wrote in with a question about feeling really crappy post-detox. This person had been taking OxyContin for a little over a year, at between 90 and 400mg per day, but usually around 90-120mg. They ran out of cash and got their doctor to prescribe Suboxone. They were able to taper from, as far as I can tell, 16mg per day to one-quarter of a tablet or a film (they used both)—which, depending on whether they were taking the 2mg or the 8mg formulations available in the U.S., means they were dosing at either .5mg or 2mg per day at the end. It’s unclear from the way the email is written exactly what dose they jumped from at the end.

This is important, though: the jumping-off dose. Get to that in a minute.

They write:

In the last two days I have altogether stopped taking it. The problem is I have been experiencing extreme tiredness; major digestive issues, especially gastric reflux and an on and off “lump in my throat”; and muscle weakness. I am a middle-aged cardio athlete and I now have extreme sensitivity to air conditioning or temperature change between rooms at the gym. Overall I feel like I gotta be dying of cancer or something is really wrong with me! I am not sure how long this is going to last and have yet to come across an article describing Suboxone withdrawal and how long it may take for me to feel “normal” again or if that is even going to be possible? I am kind of determined to stay off the Suboxone as I believe is causing me lots of physical problems I don’t read about in the “side effects” articles. Is what I am experiencing “normal” and if so how long do you think it may be until these awful sensations and other problems go away?

The experience this person is writing about is called “post-acute withdrawal syndrome” (PAWS). What this means: after we’re done with the “acute” detox—the period of time in which the body is getting rid of the remnants of drugs still in our systems—there can be another phase of detox that is “post-acute,” when the body is still working to heal from the effects of our addiction.

Suboxone, like methadone (or any drug with a long half-life), takes a long time to be excreted by the body. It’s not like the day you stop taking it, your body is free of the drug. One nurse I know who detoxed from Suboxone put herself through urine tests, and could detect Suboxone in her blood up to three weeks after jumping.

One critical thing to remember about the healing process after detox: Opioid drugs hijack our body’s ability to make its own opiates, called endorphins. When we’ve hijacked our body’s ability to produce endorphins, and we detox, it takes a while to heal.

So ALL withdrawal symptoms mean the body is healing. Withdrawal is a healing process. (It sux, but it’s healing. :))

The symptoms of opiate PAWS include some of the ones mentioned in this email:

  • Persistent fatigue: endorphins help regulate the body’s energy; when we take extra opioids, it can affect our endocrine systems, which regulate our metabolism and sex hormones (many opiate addicts have experienced lack of sex-drive, women sometimes go into menopause, and men sometimes demonstrate low testosterone levels). When we detox, these systems don’t just switch back to “normal” immediately.
  • Digestive problems: this person has gastric reflux and a feeling of a lump in the throat; other people have persistent loose bowels and lack of appetite. Did you know that the brain isn’t the only place that has opiate receptors?—the entire GI tract is lined with them, especially the “gut” or intestines. Which is why opiate addicts usually experience constipation: opiates slow down the body’s “autonomic” functions, including digestion (and breathing, which is why ODs can be lethal, and why morphine is standard treatment for people at the end of life experiencing “dyspnea,” or breathing problems). When we detox, suddenly the GI system is shocked back into action, because there’s nothing numbing it anymore. It takes a while to settle down.
  • Temperature sensitivity: endorphins help regulate the body’s thermostat. When we take extra opioids, the body’s ability to perform this function on its own is compromised; when we detox, it takes time for the body to regain this function.
  • Sadness, anxiety, and pessimistic feelings: This person says they feel like they might have cancer, or that “something is really wrong.” Just as opioids numb certain physiological systems, they also numb our feelings. (Candace Pert, the neuroscientist who discovered the opiate receptor, calls opiates the “molecules of emotion.”) One of the main reasons opiate addicts choose opioids over other drugs is because these drugs are so efficient at numbing emotional life. But when we detox, all the feelings numbed out by the drugs come back, and because our native endorphin production is out of whack, it takes a while for our body-mind to begin to “feel” in normal ways again.

Who gets PAWS: There’s a ton of stories from people who have detoxed or tried to detox from Suboxone demonstrating that many of us experience PAWS. On the other hand, some people don’t experience much PAWS at all. A great deal depends on the differences between each of our bodies and minds, as well as how long we were taking drugs, what level we detoxed from, how low a dose we tapered to, how well we’re taking care of ourselves, and how much support we’re getting.

 

Tae Kwon Do

Tae Kwon Do: “Lies My Mother Never Told Me,” a memoir by Kaylie Jones, describes how the author recovered from her alcoholism in part through this discipline.

Some common-sense tips for managing PAWS:

  • Shorten your detox: If you want to use Suboxone to detox, try to stay on it a minimal amount of time. The many personal accounts I’ve heard, as well as some professional opinion, suggests that people using Suboxone to detox should try to use it no more than three to four weeks. Beyond that, the body begins to get used to Suboxone (just as it becomes used to any opioid after such a time), which can become a problem in and of itself. Again, this doesn’t seem to be the case for everybody.
  • Taper as low as you can before jumping, especially from long-acting drugs such as Suboxone. In Europe, buprenorphine is made in doses of .2mg, which is helpful for tapering to minute doses. In the U.S., tapering this low has to be done by splitting 2mg tablets into slivers of a quarter or an eight-milligram, or securing the films, which can be cut to facilitate very low tapering. As an example, I tapered to .125mg (one-eighth) before jumping. Those who jump from even 1mg usually have a rougher ride. It’s estimated that 1mg Suboxone equals about 33-40mg morphine (in binding power). I wouldn’t want to jump from 35mg morphine.
  • Begin serious daily aerobic exercise, as soon as you know you want to detox. Exercise is one of the best ways to help the body restore its own endorphin production. … I detoxed in the fall. I was exhausted, but I loaded upbeat songs on the iPod and dragged myself for a 20-minute walk every day, going as fast as I needed to go to sweat. I also rode a stationery bike. My sleep and temperature regulation wasn’t great when I finally jumped off Suboxone, but today I sleep normally. Even better, I can cycle 30 miles, play 2 hours of tennis, clean the house; and two days ago I scored my first pull-up. Yaaaah!) We do heal.
  • Ask for some kind of 3-D support. Work some kind of program of recovery. The way I look at it: when I broke my elbow, I had to do PT, right? I can’t numb out my body and feelings without doing some kind of repair work. I started going to 12-step meetings, and sharing my experience with and learning from others who had been through the same thing helped ease the anxiety and let me know I could get better. It doesn’t have to be meetings; it could be therapy, or a spiritual community, or a physical discipline such as Tae-Kwon Do—anything that helps us enlarge our perspective and grow.

A great resource and support for those detoxing from Suboxone is the Suboxone Forum at Opiate Detox Recovery.

Please share your experiences here, too. And if there are any physicians or researchers who can point to studies about PAWS and Suboxone, please give us a heads-up. I checked Ovid this morning and couldn’t find any. … Not that studies tell the whole truth, but this reader was looking for “articles.”

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Also, please visit my new site: Recovering the Body.

119 thoughts on “Suboxone Detox and Post-Acute Withdrawal Syndrome

  1. Hey Subhell,
    Man I feel all that you are saying but please hang in there for my sake. This site we share our nightmares with subs, we are all common yet unique in our experiences of getting through. Nothing replaces live conversation but in a way it is very much like a meeting. My hope is in you getting well and my hopes are strengthened by successes and even momentary failures because we all have the desire and willingness to beat this and get well. We are each others strength in many ways. I learn I live it I share it and somewhere in the clutter of all this a light shines for me knowing I am not alone. Hang in there and even if there’s a slip come right back ’cause everyone on this page needs hope for the battle to be won. And cliche or not brother there is strength in numbers. Simply Black
    I’ll have started a prayer list you are on it!

  2. A good evening to all of you. This will be my last blog for a time. I saw my addiction doctor and told him I want off. His plan is @ 16 mg to take 2 mg away every other day. And then they will continue that each month. Do the math it will take two years to get tapered off. I told him sounds like a plan and told him to look at this web-site. He told me he knew better than things I shared with him. He was the expert. Yeah we’re just the people trying to tell a horrific story of us, THE TRUTH!!! So little does he know I am only doing one 8 mg film each morning. Will taper myself. This site is a God send. Then I went to my primary doctor afterwards and tried to express the truth of this drug and he began in a sense defending suboxone to a degree. They now give it to me for pain – doesn’t matter that I said drug maker site says NOT TO BE PRESCRIBED as a pain medication.
    I can’t find any sanity. I am not sleeping. So here’s my plan tonite. Making dinner and at the twelve hour point since doing my fun film I am taking a zanex and getting much needed sleep. Why all the lie’s and cover-up for this drug? Please someone tell me.

  3. Guinevere – Have to share my visit Friday to the suboxone doctor. He asked me if 16 mg a day was enough to with my pain. I told him no and I want off. His taper down plan would take two years for Gods sake. I said there are people that believe 16 mg is too large for a maintenance dose. He asked me where and who and I gave him this web-site. He said they are wrong I am the expert. Then he asked me about meetings and I told him when I say I’m on suboxone they say I am not clean and by their rules I am not allowed to speak. They say very kindly. Now my doctor says that I am to tell them to tell my doctor ’cause he wants to know why they’re so busy in my fourth step. I respected these people and I liked what I heard – I would never ask such a stupid question of them. They explained it to me with love and kindness merely stating the obvious – I am not clean. I wasted 28 days being lied to straight face while I cried. That line holds more meaning today.Simply Black & completely amazed at what these doctors are getting away with. Of course I’m the stupid one for saying uh huh everything is just dandy now.

  4. I have questions regarding detox and suboxone but would like to speak privately. Please email me. Thanks. :))

  5. I’m on day 4 and everyday is getting better. I realized quittin pills cold Turkey mighta been a better idea, not sayn i wldnt do it all again perks and roxys have ruined my town and friends. But glad to see other people optimistic on the other side of tha fence.

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  7. Hi people. I am at around three weeks, I think. I quit subs cold turkey. Im a vet who was prescribed it due to PTSD. I dont know what my doctor was thinking. Suboxone is a very VERY, powerful opiod antagonist. After reading as much as I could about the medicine, I realized its true purpose and was shocked that I was on it at all. So now I find myself among all of the people in this same dishwasher of pain and discontent. Im on here to help anyone who needs it. Im sure helping will help me just as much. I physically and mentally couldnt even type on this site until today. The foggy brain was unbearable. I couldnt get up. I couldnt concentrate. I have also been dealing with a severe cold. Pray you dont compound the problem like happened to me. A cold really made things worse. But I have an incredible woman by my side! She has literally saved my life while I have been fighting this. Im not sure if Im turning the corner for good or if its just a good day, but today has been incredible. I can actually look straight at things and see them. If your having trouble simply looking at things for more than a half second, than I suggest you check your pupils.. they may be dilated and sensitive to light and have trouble focusing. Its not permanent and its not something to be scared of. Also everyone talks about the cold sweats. The chills. Regulating body temp. The most likely cause of this is you may have a constant fever. Check your temp. If your having a fever you need to continuously monitor yourself and drink half water, half gatorade. Drink it cold if possible. I did spend one day in the hospital when my fever spike to 102 I had my gf take me to the hospital. I realized I was in bad bad shape. It helped me allot though. Human beings need to be loved. I dont care how tough we think we are. Our endocrine system is tougher! And the suboxone has shut down a very important naturally occuring happy drug we create, shut it down completely. You have to always remember you are in charge of your fate. Are you going to let this beat you? NO. Do whatever it takes. Immodium AD can change your life! Having loose bowels is also common. Its also another way we become dehydrated. Take Immodium AD and keep hydrated. Tylenol is best for any fevers and body aches. With the constant leg aches, I found Bananas can help allot. Just like bananas help with sore muscles. All of the things you experience through this painful process is simply your body kick starting (in a panic) all of the naturally occuring things your brain has not been able to do while we were taking the subs. Our entire body goes into a very long and slow state of SURVIVE. Its the survival response that makes us feel so badly. Its possible you may be fine all by yourself. But like before I can not reiterate enough, we need someone to help with this Hell we have gotten ourselves into. If you are currently feeling like your never going to feel normal again, just remember that all the stories on here say “you will be ok” This will all pass. And your next month should be better. Then the next month will be even better. Until we are in a state of mind where we never forget the Hell we survived! So fight ladies and gentle men! There are many of us out here in your same shoes. Even though every experience will be different, the facts about our health while going through this applies to everyone. Keep hydrated. Keep your electrolytes up. Eat whenever you can. Use Immodium AD. And find a way to stay motivated.

    Thanks for everyones time
    God Bless
    BC

  8. I am around day 7 of coming of subs. I took about 4 a day for approximately 2 year (way too long). I weaned myself off thinking I was doing the right thing. I got down to 1/4 of a tablet an it has been hell for 7 days. I can’t eat, I can’t get out of bed, I’m freezing and sneezing all the time. And the depression is awful. I actually came home from the grocery store 2 days ago and pulled in the garage. I cut the car off, and I just sat there staring straight ahead. All I could think of is cranking the car, and letting it run and just sitting there with the garage door closed. That would end all of this misery I’m feeling. Of course I didn’t do it, I have children. I’m not that selfish. I just don’t know how long I can take this. I have thought about getting just one bottle of lortab and taking once a day. Has that helped anyone? Or is that just trading one evil for another? I need help. I thought about going back on subs but I don’t want to do that. I feel like I will never get off of it.

  9. Good early morning to all, I have not blogged for three months. I refer to my suboxone doctor as my nut doctor. At 16 mg a day I began having such vivid dreams that lasted 15 minutes after waking up. Serious crap that the FDA recorded. My nut doctor believes that as I deal with pain from so many surgeries that it would help to increase my dosage. Another man prescribing without any real knowledge of subs and their effects. I dropped to 8 mg pr. day. Once in the morning. It has been 6 weeks now and I am feeling more in control. At my appointment after countless times of trying to talk I now just say – Uh huh yep everything just great – Pain – nope ain’t got none. I am getting off slowly as they could care less. Oh yeah the company that makes this crap (160 billion last year)
    can’t or won’t answer any legitimate questions – folks we are on our own. I am lowering to 4 mg starting today and expect and plan on things going just as well as the first drop from 16 to 8. When I said we are alone – we are not. Aside from my spiritual beliefs I have many people I talk to and this wonderful site to air out. God Bless each of you – comrades in this battle to defeat this cure all drug suboxone. Oh yeah – everthing just great – uh huh – no pain – uh huh – I just love my healing so well because of your great help with subs. Uh huh I am soooooo grateful – uh huh yep
    see ya in a month. OK that’ll be 100.00 please!

  10. I am praying for you Simply Black. The Lord bless and keep you. The Lord make His face to shine upon you and be gracious unto you. The Lord lift up His countenance upon you and give you peace and joy <3

  11. If you take any opiate with Suboxone….it will throw you into withdrawals. Please be careful <3

  12. Amen!! That’s basically how I got to where I am at! I just do not have the will to only take half twice a day. If I have 10 vicodins, I would take every single one at once!! I would not recommend this to anyone <3

  13. This is the way I am trying to look at it. I know most don’t believe in the power of the Holy Spirit but GOD is real! I was baptised in the Holy Spirit about a year and a half ago and I truly believe that this is the only way I will be able to kick Suboxone after being on it for 6 years. I quit one time for 6 days, trusting in Jesus but I lost my faith too quickly. The crazy thing is that I didn’t have ANY withdrawals and still gave up. I am hoping and praying that this time I can keep my faith in Christ and not give up. I am praying for every person on this forum and who suffer from addiction. The Lord bless and keep each one of you and may He give you peace, joy, and strength that you need to get through it all <3

  14. WOW – on day 8 or 9 and had avoided ALL posts bc I can watch a commercial about to email fungus and swear, next thing you know, I’ve got it. The point, at day 8, being unable to muster the energy to lift the remote for a bit, I searched, read THIS, am done and outside walking and texting. Thank you – boxing gloves on bc no one and nothing is gonna call me or make me a wuss! Seriously – thanks and gratz on your battle!

  15. Hello, I am so glad to hear from another that had the identical experience. I was on Sub. For a little under 6 years, I jumped a 4 mg. I had to check in to Detox after day 6. The first 14 days was hell. I am at 35 days, and a lot of the intense withdraw has subsided. I am finding that everyday at this point, that I feel better in the morning, after only 3 hours of sleep (Somnipure helps) and it last a little longer every day. By the end of the day, the withdraw seems to be at it most uncomfortable point, then the cycle of trying to go to sleep starts again.
    But gets minutely better everyday. I have been told that after 45 to 50 days a lot of the discomfort subsides. Fingers crossed, for a happier future. Hang in there it does get better.

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