Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Suboxone Detox Redux.

Four years after posting this interview with Dr. Steven Scanlan of Palm Beach Outpatient Detox, I’m still getting mail about how to tolerate Suboxone withdrawal. This piece and a couple others I’ve written rank in the top 10 in Google searches, and over the years I’ve been so deluged with comments and private emails about people’s struggles to get free of this drug that I keep a huge separate file for them all. I’ve talked or exchanged emails with some of these folks, and eventually I plan to put out a booklet that collects people’s experiences with this drug that is—depending on where you live—variously doled out like candy by doctors who don’t understand its strength, or available only if you drive two hours or three hours through the wilderness and pay cash to doctors who run their Suboxone clinics like whorehouses.

A reader named Bob wrote this morning:

I was using 16mg a day for 2 1/2 years, I was in excellent physical shape, ran 4 times a week, multiple half marathons, but felt enslaved to this drug. I went to an out-patient 6 week detox program, just in one week I went from 16 to 8 a day, next week went down to 4 a day, then the following week I went down to 2mg a day for a week before I “jumped”, I stayed off of it for 2 days, had ungodly withdrawals, so they gave me 2mg for one more day, I then went 9 straight days with nothing before I did 4mg on a relapse, now I am at day 6 with nothing. I am a business owner and cannot afford to be ” on my game”…any ideas as to when it gets to be ” manageable?”

I think Bob meant he couldn’t afford to be OFF his game. It seems like, in his detox center, they wouldn’t let him taper down to the minuscule doses that are most helpful in Suboxone detox. Many, many practitioners prescribing this drug do not understand its pharmacokinetics—how it behaves in the body, and how the body processes and neutralizes it. They think 2mg is a small amount.

 

A Suboxone film, cut for tapering.

A Suboxone film, cut for tapering.

Look at this picture. This is how some people taper off Suboxone. They cut the dissolvable films into little bitty pieces. The company that makes Suboxone does not advise doing this, because they say they can’t guarantee the drug is evenly distributed throughout the film, but guess what?—I think it’s because they don’t want people to taper off it. I’ve talked to Tim Baxter, M.D., global medical director of Reckitt Benckiser, manufacturer of Suboxone. In two separate interviews he told me, “We don’t promote detox.” They want you to stay on this drug. But you don’t have to.

Disclaimer: I’m not a physician, I’m just sharing experience and making space for many others to share theirs. If you want medical advice, you need to see a doctor. ... That said, Bob, 2mg is a significant amount of bupe to jump from. Like jumping from about 60 or 70mg of morphine (the gold standard drug to which all other opioids are compared in their analgesic and receptor-binding strength). I was tapering off the equivalent of 400-500mg morphine per day, and I used Suboxone for two months. I jumped off about 1/8 of a milligram—the tiniest bit in the photo above. Dr. Scanlan and other doctors who understand buprenorphine, the opioid drug in Suboxone, taper people down to fractions of a milligram before they jump.

So you’ve been six days clean after taking 4mg, and you continue to be physically active? Awesome job. Keep it up.

Some tips—take what you need and leave the rest:

  • Get good food. Eat no sugar, no caffeine, and as much organic protein (meat, fish) and vegetables and fruits as you can. Fuel your body well.
  • Get good sleep. Don’t take sleep aids, except for maybe benadryl or melatonin, which Dr. Scanlan prescribes during Suboxone detox (see above). A low dose of gabapentin helped settle my legs and get sleep. Hot baths also did the same thing—fill your tub with scalding water and enjoy feeling your muscles relax. Scanlan also prescribes Librium (chlorodiazepoxide)—if you can get a provider to help you for a month or so by prescribing a low dose of this, it may help you sleep.
  • Keep exercising. This will ease your restless legs and arms, reset your opioid receptors, and increase your energy levels and your appetite for good food. Yoga is also effective to stretch and relax the muscles that feel cramped and jumpy.
  • Meditate. Research shows that for recovering addicts, meditation restores the connection between the limbic brain (the part where cravings live) and the prefrontal cortex (the part that lets us make good decisions). In detox and post-acute withdrawal, meditation calmed my mind and helped me understand that every goddam moment of detox passes and that I could make good choices to foster my health.
  • Read Dr. Scanlan’s paper about Suboxone detox. Pay special attention to the section called “The Jump,” in which he says he tapers people down to very low amounts and advises his patients to stop the drug when they have a week or two to take it easy on themselves.
  • Find a supportive community. Anyone who has been taking Suboxone is struggling with an addiction. And nobody gets sober alone. We all have to learn to ask for help. When I was detoxing, I needed to be in touch with people every day. I did this partly on the public forum Opiate Detox Recovery (which has a special Suboxone forum), and partly in a 12-step program, where I got a sponsor who I called almost every day, and where I went to meetings where I met people who had done what I was trying to do and were holding down jobs, raising kids, and most of all being happy.

Even more information about how to take care of yourself while detoxing and dealing with post-acute withdrawal is included in my book, The Recovering Body, which you can get on Amazon and in your local independent bookstore. 

Edit: Here is an email from a guy called Larry that came in several days after Bob’s:

I’m a 60 yr old male engaged in hiking, climbing and biking.  I’ve had a 15 year long opiate addiction.  I’ve used suboxone for 2 years.  I started at 4mg.  I requested the low dose as I felt 8mg/16mg was more than I needed.  I reduced my dosage from 4mg to 1 mg over 4 months,  from 1mg to .25mg over another 4 months.  I jumped off from .25mg  ( 1/8 of a 2mg strip).  I had moderate WDs for a week, 3 weeks of significant lethargy and continuing mild lethargy.  I’ve been clean for 2 months.   I can feel it getting better and I’m staying the course.  I really don’t have any choice.  The alternatives are all non starters for me.

If you don’t make it this time, taper to a lower dose, no more than .25 mg.  It’s worth doing.

(Emphasis mine. 🙂 ) Fifteen years on opioids, and he’s now free. Congratulations, Larry.

Good luck to Bob, Larry, and the countless people out there who are trying to get free. Let us know how it goes.

Recovering Body_small

5 Comments

  1. Thanks, G. I cold-turkeyed (no taper) off a 16-20 mg dose that I had been on for 4+ years. Interestingly (perhaps), my experience was not much different than Larry’s. I suspect my “lethargy” may have been more severe than his (at times I had difficulty walking), but the duration was about the same.

  2. guinevere

    April 15, 2015 at 2:05 pm

    Thanks, Steve. How old were you when you jumped at 16-20mg?

  3. I was told suboxon was my cure all,so i went from a fifteen year addiction to oxy 80’s,coke,crack,n everything else i could get my hands on,to 8ml of sub’s two times a day.at first i thought,i had found the answer to my prayers. And then i started gaining weight for no reason,withen two months i had gained 60lbs,my feet n legs started swelling.fast forward to a year later,i was 100lbs heavier,lower body still swelling,lymphnodes swollen all over body,lathargic as can be,i was soo weak,felt like i couldnt take full breaths,and no one could give me answers! I was diognosed with thyroid problems,low iron,my vit.d was extreamly low (3),i felt like i was dying,then all of a sudden my arms started feeling heavy,went to hospital after two days of dealing with it,at the age of 29 i was diognosed with coranary artery disease! My body was falling apart,my mind couldnt handle much more,i tried tappering off the subs numerouse times n succeded at one point for two months,n withen those two months,i started feeling better,my health started to come back to normal,then i relapsed with pain pills,so i went straight back to suboxons.my health went straight back to being horrible again..i was a healthy person before suboxon,and it really has taken so much away from my life..im now preparing to go off of it again,im 100% mentally ready,im sick of feeling soo sick.but im procrastenating the start day because of the fear of withdrawl.ive herd it doesnt matter if u tapper or just go cold turkey,the wd is just as bad either way,so im just hoing cold turkey,cuz thats what ive always done.my question to everyone is,has anyone else delt with the savere side effects of the suboxon to there health??

  4. Please please please do not spread any more anti-maintenance stigma. Scanlan himself has (finally) even admitted that maintenance is necessary for some people. To try these people on abstinence is to seriously jeopardize their lives. The fact of the matter is that PEOPLE ARE DYING all over the country as well as here in South Florida as heroin continues to leave its mark on an entire generation of people. Suboxone is an incredible drug that has given countless people a new chance at life, however, many people quit abruptly and endure horrific withdrawals due to judgment and societal pressures. Also, I think it is pretty important to note that not many people who are dependent on illicit opiates can afford a $2000 outpatient detox.

    I know this post is old, but I just want you to examine a statement you made and think about what impact it might have on someone reading your blog. “Anyone who has been taking Suboxone is struggling with an addiction.” Wrong. This is an ill-informed, dangerous statement. They are in remission from their addiction, even according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. Let me ask you: do you consider someone who has come off the streets, stopped injecting drugs, found a steady job, and reconnected with his/her family “struggling with addiction” just because they is stabilized on buprenorphine? I really hope not, because that person has done the seemingly impossible and reclaimed their life because of buprenorphine. I applaud you for taking control of your life and putting a stop to your chemical dependency, however as the opioid epidemic grows to unprecedented proportions, I am afraid we need maintenance more than ever.

  5. Thanks for reading and for your dedicated response. I don’t consider my material to be spreading stigma. I’ve always said on this blog that I respect any way anyone looks for recovery, including maintenance. I have no problem with anyone who WANTS to be on maintenance. I do have problems with the many doctors who charge exorbitant fees and prescribe in enormous doses. I have problems with any physician who tells any patient that they will have to be on any drug for life if that statement goes against a patient’s wishes. That goes for people with cancer, diabetes, high blood pressure—any life-threatening illness. (Anybody taking chemo is struggling with cancer, even though their body may at that point be cancer-free.)

    If a patient doesn’t want to take a particular drug and would rather seek a different mode of treatment, the medical community should support that choice, but that is not happening with people with addiction. People who have struggled with opioid addiction are routinely told they will “never” be able to live without taking some kind of drug, and this is just patently false, regardless of what the DSM-V says.

    My posts about Suboxone are responding to the people who write me asking for advice about how to quit taking the drug because they can’t find a professional who will help them. Is it your opinion that I should tell these people, “It doesn’t matter what you want—you should stay on this drug forever because PEOPLE ARE DYING and the DSM-V says you can’t have the kind of life you want”?

    People write me that they can’t eat, they can’t sleep, they can’t have sex, they no longer have feelings, they have dental and vision problems. Is it your opinion that we should ignore these effects of the drug because “PEOPLE ARE DYING”? My opinion is that we need to take a hard and nuanced look at the ways these drugs are prescribed so these effects can be minimized. But in this country, we take a carpet-bombing approach to most problems. You may work on the front lines as a first-responder, and having seen many people in my own family die of addiction, I respect what you see out there. But not everyone by a long shot reclaims his or her life through buprenorphine. Far from “spreading stigma,” I am advocating for those who want help taking charge of their own health care and making their own choices. (And P.S.: I’ve said on this blog that Steve Scanlan thinks a proportion of people with addiction require maintenance.)

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