Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

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 detox doc 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 eighth-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 stationary 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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17 Comments

  1. I’m so thankful that you people know of exactly what I’m feeling and can tell me the common symptoms and lengths of time generally involved.
    I “Jumped” 4 days ago and unfortunately I have a severe knee injury that’s 7 days old and still have to work. I have no other option..
    Working with Paws and knee injury for 4 days..
    I absolutely must get through this but I had no idea how long the withdrawal would take.
    I’ve been on bupenorphine for about two years.
    This is the first time I’ve read others accounts.
    One more question?
    What about relentless nightmares???
    Ps. I’m also working on my alcoholist addiction.
    Thanks again.

  2. For the past 2 weeks I’ve kinda been tappering off I was prescribed 16mg a day for 2 years taking them for almost 4 years I lost my health insurance in March since then I’ve been buying from friends recently it’s become impossible to find them. I’ve tried before to get off and gave up after 2 days I’ve been mentally done with subs for awhile just never had the courage or time to get off of them. I’m 23 work 2 jobs 5 days a week 18+ hour days I’ve detoxed from opiates on my own after 3days was fine. I’m currently taking .007mg a day for the past week and still when I wake my body wants it. I’ve been having horrible intense stomach pain that come and go. Tried all the time, walking up a few steps I start sweating. I’m either burning up or freezing. I go back to work Sunday night and I’m honestly scared I’m going to give in I need to work. Hopefully it gets better!

  3. Great advice. How long were you taking suboxone before you quit?

  4. Hey everyone – I read a lot of your stories, good reads I’m proud of you guys/gals! I’m a 27 year old male – was on suboxone for just shy of 3 years @ 8mg a day along with 3mg a klonopin and was doing 10-20 perk 30s per weekend. It was a viscous cycle. Today I’m 25 days sober and have had my ups and downs. I jumped off the subs at 2mg, kpins at 3mg. When I got to treatment they detoxed me with phenobarbital for 14 days, along with clonodine. Days 15 when I was off all meds I felt like hell – couldnt sleep for a minute, chills, anxiety through the roof, bad fatigue and my hands sweat all day long while i wasnt trying to sleep, along with minor headaches. I got my sleep back around day 21 – started getting about 6-7 hours a night – been gaining each day. My main symptoms now are minor sweats, bad fatigue, some anxiety. Just take it one day at a time! This is the longest ive ever been sober and I will NEVER take suboxone again, would rather have dealt with perk withdrawl on my own! Goodluck!

    Joe

  5. Joe, how wonderful for you to kick Suboxone and Klonopin. I’m willing to support anyone who wants to get off Suboxone, which is why I write these pieces. I hear from so many who no longer want to be taking that drug. If you can get your body to exercise, it’s the best beginning toward regaining your energy. Take a look at my book for more information. /G

  6. Well, here’s the dirty little secret that you only find by reading the “product data insert” and doing a little math. Suboxone has a mean (average) half-life of thirty-seven hours but it is prescribed on a twenty-four hour basis. Generally, most opiates have an average half-life of only four hours. Simple math tells you that half the drug is still in your system after thirty-seven hours, so if you take another dose in twenty-four hours you are adding drug to you body’s total serum level. This paradox is vaguely explained in the product data sheet. It explains that you eventually reach a “saturation ceiling”, a blood serum level where any additional dosage cannot be used by the body, the extra being wasted. So, if you take 8mgs/day, every twenty-four hours, you have only excreted 2.59mgs the first day, so when you take 8mgs more you now have a blood serum level of 13.41 mgs. The buildup becomes exponential from there until you become saturated. This phenomenon is the reason why you can taper almost immediately, saving you money with no ill effect. However, if you want to quit Suboxone by tapering, you must take into account the thirty-seven hour half-life and forget about dosing every twenty-four hours. You must reduce your blood serum level over time in order for a timed reduction to be effective. If you try to taper by halving and forth-ing until you have the smallest of partitions using the twenty-four hour schedule you will never have reduced your blood serum level at all. You will have the illusion that you will have minimal effects when you jump but you will get the big surprise. You should have saved your money and jumped at 8mgs/day…there would have been be no difference.

    Here’s another dirty little secret…reducing you blood serum level by taking into account the long half-life has its own misery. As your blood serum level actually drops there comes a point that saturation no longer occurs so the withdrawals will start at some point after that. The longer you take to reduce your blood serum level the prolonged the misery. Once your body falls out of saturation you will start to have some withdrawal symptoms, how bad depends on the person and how long they took Suboxone, how obese they are, how old they are and what state of health they are in, all are factors. Remember, your body was saturated, each person has their own dosage level where they became saturated, so reducing the dosage based on half-life may require time to reach a symptomatic level and the symptoms may be tolerable to some degree. Naloxzone , the ingredient in Suboxone that prevents the use of opiates, only lasts for hours, which means you can manage those symptoms with some mild painkiller like Vicoden. That’s like robbing Peter to pay Paul but most people who have successfully jumped have used something to minimize the misery but only when absolutely necessary.

    Most people, after having quit for thirty days, usually call the doctor for some additional Suboxone thinking that they can take a little portion to reduce their misery but end up putting themselves back into saturation, prolonging the misery, not reducing it. There are some experts that say that prolonged use of Suboxone causes damage to receptors and other parts of the neurological/psychological system of the body, so to have success with Suboxone one must only use it initially, no more that twenty-five days, tapering almost immediately upon the initial start. It is a designer drug and does not fit the neuro transmitter/receptor pathway like endogenous (naturally occurring) endorphins created by the body itself. Although this potential hazard is not mentioned in the product data insert, there are some prescribing doctors who postulate this anomaly. It is possibly why it is so hard to return to normal after Suboxone for some people. Others have suggested that it causes permanent damage suggesting disability.

  7. It has been 3 weeks and I an still sick in way not like Opiates or methadone.I was on this for 9 years they said for pain management. What a lie. Not sleeping starting to holucinate see weired things with very bad headachs.Plus my back pain has worsened and I am looking into that finally. Aii I can say at 64 this stuff is BAd BAd BAd and I thought methadone was bad. Jack W

  8. I ended up on methadone after a bout with shingles and it was said to be the ” gold standard ” , of what I don’t know . – 10 YEARS at doses up to 180mg a day ! I one day , by the grace of something far greater than I – said to my wife at age 50 this has got to stop or I’m dead . 100 lbs overweight and all around dying inside and out-spiritually bankrupt – I took off for rehab – they tapered me one week with suboxone and after that week – for the next year I was sure every second of every day I was going to die any minute -it was like no reality of suffering I can recall – I returned home 60 days later – still felling more dead than alive – I had to see a dr as I was SURE I was dying somehow . This dr rxed me on suboxone – starting at 3X 8mg sublingual buprenoperine ( no naloxone )
    And it propped me back up !! Amazing – then two years later I realized this ” dr ” had little or no intention of helping me be free of this , yet another addiction .
    I asked repeatedly and was told , oh no you need to keep taking it -the voice inside you is the one I am learning to listen to – we ALL have the answers to all our questions and this was also clear – first 7 days ..a breeze as I excercised every day – ate clean whole foods ONLY and attend groups (, prayed like my life depended on it ….it did )all willfully –
    I’m on day 11 . I feel and look great , yes the chills suck , my stomach gets pepto bismal daily , etc . and I will make it – don’t ever ever ever ever ever give up on yourself . You can do it and life before drugs was great , and this experience I am 100% certain will enrich the remainder of my life as I try even now to just think of other people in need – and myself as little as possible .its not easy , but pain builds character and effects change – embrace the pain – forge ahead .

  9. Lorie Montgomery

    March 5, 2017 at 12:48 am

    Suboxen is not a good drug at all. It is better than natcotics and I don’t recommend them. Plus it takes about 45 days to get over the paws. And after a year I’m still craving it. Sucks. Go through withdrawal on your own your better off. Really sucks to think I was 8 days in from my natcotic withdrawal when I started suboxen treatment. Thought I was finally getting clean. Your not clean at all on suboxen.

  10. Iam glad to find this. I am struggling with addiction. I did opiotes for about 2 yrs. Snorting heroin mostly. Never used needles. Weened off of that. Onto soboxxone. Its has been about 11 mths since i started taking subs. Within thaat time i went from 8mg a day to slowwwllyy went to 6 to 4 to 3 to 2 and jumped. I am dealing with PAWs leg shakes and tempature is so messed up. Anxiety is horrible. How do i minimize these symptoms? I have been taking a vic here or there or even a valuim or xanax to help with my anxiety and leg shakes. I have relapsed a few times. Falling off the map for a day or 3 and then taking little bits to ease my withdrawal symptoms. Doing good lately staying away from both H and subs. But i really cant find the motivation or energy to get up and do anything. My nxiety is TERRIBLE. leg shakes every morning every night toss and turn at night. Not as intense as in the beginning but still there. And its like i cant kick these symptoms. Im always so hot or so cold. My feet and ankles are freezing. Or i cant stop moving them. No energy. Ive got brain mush. No support really. Sometimes head aches. Any feedback will be helpful. I want to get more subs because these symptoms are taking FOREVER it seems to go away. Its has veen about 2 weeks sence ive jumped off subs. Help me?

  11. My name is amy ive been on subs for 3 years after an addiction to vicodin. Im on day 9 of quitting the subs and i am so depressed. All i want to do is stay in my room. I do go to work but afterward i dont want to live sometimes please tell me how long til i ca feel happy again. Please help.

  12. I have struggled with opiate addiction for MANY years. Personally, now that I am recovering for my third time from Suboxone dependency, I do not believe it is the answer for recovery unless used for maybe a couple of weeks. I’ve been through inpatient programs. This time I went against most advice and did it on my own. As many addicts have heard many times, alot of it is mental control. I am on day 8. I did use a couple benzos a day the first couple of days to help. Now it’s all me. I really don’t have much withdrawal symptoms left. My stomach pain, aches, and lack of energy are the main things. Trying to learn all I can about how to heal my body. Lots of protein, exercise, lots of water, NOT SWITCHING TO ENERGY DRINKS, and considering getting some DL Phenylalanine but don’t really know much about it or if I still need it at this point. I am not one to push God on anyone but prayer and strength from the Lord IS what has gotten me through this without feeling like I want to die or having to leave my family again for inpatient treatment. Good luck to you all! If I can do it, anyone can. If anyone has any advice on what I can add to my game plan to get back on track, especially with my energy, it would be greatly appreciated! God bless!

  13. Good morning, Ive been reading post after post and im so afraid of what the future holds. I was a long time heroin oxy user and got clean may 9, 2011, my son passed away january 2013 and wanting to start using again i heard about subs went and started seeing a doctor and have been on 16mg since the death of my son but im so ready to be really clean again. Basically im starting day 6 as we speak with no subs for the last 6 days and my wt symptoms are very minimal, im 35 and have detoxed 50-60 times over the years so id say im a vet but ive never detoxed off of subs, now the only difference is that i never needed to tale my recommend dose of 16 mg’s every day i could go 2 or 3 days without needing it idk why its just how it worked out so my question is since my withdrawl stmptoms are so minimal is that because of the way i used subs or am i in for a rude awakening in the next few days, thank yall so much for everything Daniel S. New orleans la.

  14. Hi everyone, first and foremost, to all of you, whether you have fallen back on this drug or you are sober and going strong, you all are so brave and strong. I don’t wish this type of feeling on anyone! I’d like to share a sensitive story with you all. I am 29 years old, have been on sub for long enough to feel the awful effects of withdrawal. I recently had to have an emergency c section for my 3rd child. I was only taking a tiny slither of 2mg/8mg of sub films a day. I completely jumped the day before I had my c section. With how much pain I was in from my surgery, I took percocet for the pain for about 4 to 5 days after jumping. I’ve never been through withdrawal, but from what I was feeling before I stopped taking the percocet, it seemed to possibly help with the withdrawal from this vicious drug. It’s been 5 days with nothing, and I can tell you that u will never put myself through that type of pain and agony again. My daughter was born premature at 34 weeks and is still in the NICU an hour and 15 min away from where I live. She is doing wonderful but still needs to grow and get stronger. It was found in her system, and mine. So of course people that I don’t really feel like dealing with through all of this, and all the added stress, has been in play through all of this too. I have been up to the hospital every single day since 11 days ago when she was born. My withdrawals started out with being constantly exhausted, yawning and sneezing. I’m sure some of it was stress as well due to the situation. Once I was completely off of sub and my pain meds I had for 4 days after being discharged, I started to get the sweats, unregulated body temps, hot and cold, stomach and bowel issues, extreme fatigue, restless body symdrome, and feeling like a layer of cement was poured all over my body. I have gradually started to feel better, but I have a long ways to go. People are too quick to judge, especially a woman that has had an experience like mine. Although I made the decision to take this drug and made the mistake, there still should be state funded programs to help out with issues like this. There is no reason I had to go through so much pain while trying to do the right thing. I really hope more options come into play in the future for women in my situation. Keep going strong everyone. Mind over matter. I know… easier said than done. If I can do it, anyone can!

  15. Thanks for all the information in your posts. Im on day 4 jumping off at .5mg (1/4 of a 2mg) today wasnt as bad as yesterday was, still have sensitivity to cold and heat. Everything smells weird, and my stomach feels like theres a hole in the middle.. itll get better though, Ive been clean for 9.5 months which is same as I have been taking suboxone. Started at 12mg, slowly weened down. This withdrawal is way easier than heroin or methadone withdrawal thats forsure — for me anyways.
    Best of luck to all the recovering addicts

  16. I’m writing to talk about my brief addiction with suboxine. I recently got down to26 mg of methadone for over 12 years so finally when I got that long they switched me over to suboxine for a little over 5 months, but I quickly got addicted to it and started abusing that so I decided this is happening all over again I actually was getting high from it. So I decided to start a taper from over 36 mg down to two weeks on one half tablets. When I took my last dose I felt good for a couple of days then it started the terrible pains in my muscles,sweats and chills, headaches,horrible nightmares and hardly any good sleep. Is this possible to get full blown withdrawals after days of feeling good down to half of a tablet?

  17. I don’t know if anyone will ever read this, but I am posting this because in all my reading I have not learned of anyone posting the experience I am having ( not a bummer post here).

    I was put on Suboxone about 12 years ago at 24 mg/ day. This is about my “saturation dose”. I took the drug almost everyday for this time.
    I am 55 yo now. I had an occasional history of Vicodin abuse( 1- 3 times per year and went to rehab in 1995 and was completely sober for about 6 or 7 yrs.

    When I jumped off, I was taking Subutex 20mg /day. This was not intentional. I made the mistake of changing doctors – and the new guy turned out not able to prescribe Subs. A 3 day weekend was approaching and I had already been out of meds for 3 or 4 days. Tons of phone calls to everyone, but no one would prescribe sub on short notice.

    So I had to jump at 20 mg after 12 years.

    They say this can be life threatening, so don’t try this. However I am now at day 25 and after reading what others have posted, I think I had a better time than when I tried to do long tapers.

    Ok I had all the normal crap for 2 weeks. Now I have insomnia ( just started dreaming in color) but get 5 hrs sleep per 24 hrs, up from 2 or 3 hrs befor.
    I still have diarrhea most but not all days.
    Tired, low energy
    . Sexual function returning.
    Headaches in the morning.

    I don’t know what lies ahead because not many have posted about this that I have seen yet. In my opinion, the PAWS, if that what this is, is the hardest because it’s hard to keep patient and upbeat. Still, I did think this would be worse based on past efforts to taper.

    Take it for what it’s worth.

    Ps

    I am healthy and have lots of support etc which is huge.

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