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.
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:
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.
Some common-sense tips for managing PAWS:
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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