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Long Term Sub Experience/Warning (Long Post)
#1
Hello all, I've been off the forums for a while due to some personal life "events" I'll call them.  However, I'm well-versed in a lot of the recovery fields practices and medications.  One of those life "events" was deciding last fall to get off subutex after 7 years.  My doctor dropped me without warning when my normal PA decided to leave the practice. This PA had been a godsend, and after seeing a few new bupe doctors (they are all over my city now, every MD is getting the license and charging cash only, its disgusting), I decided to take my last script, taper down and then ride out the withdrawal.

Basic Info: I was on 24-32mg of Subutex for almost 7 years. I tapered down from 32mg to 2-1mg (I only had 8mg subutex to taper with, so it was difficult to estimate exact final dosage) from October 1st through December 31st. The information available for patients quitting bupe is insanely inadequate/misleading, both online and in person. I had one doctor who specialized in recovery medicine tell me that after stopping at 2mg, I would be fine, with no wd symptoms lol. Another told me that my acute withdrawal would last maybe 4 days to maybe 10 days ( fun fact, it takes 13 days for buprenorphine metabolites to fully leave the body). So be careful who you pick, if you decide to use bupe maintenance as a way off opiates. I apologize if any of this is incoherent, my PAWS symptoms are still happening and I've been scripted 40mg of dexedrine to keep me moving, and I'm zooming rn. Anyway, here's where the horror story starts:

Experience: I officially was off all bupe on Jan 1st, 2018. Acute withdrawal started about 24 hours after that, as I had been alternating my lowest possible doses by every other day. Acute symptoms lasted through all of January and February. 2 months of acute buprenorphine withdrawal, people. Almost 8 weeks of hell, I can describe the symptoms but I imagine most of you know them. FYI- once your body adapts to being on subs long term like mine did, like no constipation, etc.., the rebound effects/gastro symptoms are utterly brutal. No doctor could tell me how long it would last, or when it would end. There is no scientific/medical info or studies out there about long term bupe use/ its neurochemical effects or the magnitude and details of withdrawal after long term use. Now, I'd been suffering through major depression for close to a year when i did this, and I honestly think that helped, bc I couldn't go any farther down mentally. I've been through rehab and considered checking into a detox facility, but never did and in hindsight, I'm glad I didn't waste the money on it. What meds could they give me to help really, besides something like clonidine or gabapentin? One respectable facility suggested they would switch me to methadone lol! Now, I currently have no urge to use opiates and had no urges to relapse during my withdrawal either, so the subs did work in a way, and bc of that I hoped that once I was through the taper and full acute withdrawal, shit would be ok. I was utterly wrong. The post-acute symptoms are still occurring. Once again, no MD or psych I saw could tell me when PAWS for long term (2+ years) of bupe would end, or what was happening in my brain. I was told it could be over in 3 weeks to 3 years.  Thank god I don't care about being sober, bc I got through the acute phase with super strong edibles/mmj and some small dosages of benzos (the PA scripted 30x10mg valium for the month of january lol, which was gone in 3 days i think). Gabapentin helped immensely for nerve pain/muscle cramps and spasms, and I popped .2mg clonidines like tic tacs- BUT, clonidine has its own rebound withdrawal effects that no one discusses, so you gotta be careful with that as well. Up until I really did a deep on dive on clonidine about 2 weeks ago, I was still using it almost nightly to knock myself out because I still have severe insomnia (up until january, I was sleeping like a log, and asleep 15 min after getting in bed, even during the taper). Right now I'm getting by just taking all kinds of shit, but no opiates.

My warning/message is this: If you are on subs, thinking about getting on subs to quit dope/pills, messing around with subs to stop w/d from opiate use, BE CAREFUL and DO NOT STAY ON THEM LONG TERM. As buprenorphine becomes more popular, and more greedy general practitioners decide to start scripting people subs because its easy money, there is going to be less and less discussion of how you get off them/how long a patient should stay on it. And what you need to know is that most doctors and facilities really have no fucking clue about handling long term sub use and its taper/withdrawal. I got lucky, in that I had no desire to use during any of this, and I know most people won't feel that way.

If you have any questions about any part of the bupe process from beginning to end, ask me here or pm me. I will do whatever I can to help you. I don't want anyone to go through the bullshit I did. When the acute symptoms ended, I finally got back on my phone and warned every friend I knew taking subs about what happened to me and to make sure they have a doctor who gives a shit. I hope this helps someone and that this post makes sense! Good luck everyone.
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#2
I think it makes perfect sense and it is/will be most helpful to many. I am sorry for all of your suffering, truly.

In addition to your many excellent points, I have always read/heard that docs often start patients on doses way too high.
Music is probably the only real magic I have encountered in my life. There's not some trick involved with it. It's pure and it's real. It moves, it heals, it communicates and does all these incredible things. Tom Petty
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#3
Yea also I heard about in and in medical terms is called "pumper and dumper" to solve your addiction.
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#4
Glad to see you back posting! Wishing you well and for a better time of your symptoms here on out.
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#5
(04-09-2018, 01:25 PM)FirePlaces Wrote: I think it makes perfect sense and it is/will be most helpful to many.  I am sorry for all of your suffering, truly.  

In addition to your many excellent points, I have always read/heard that docs often start patients on doses way too high.

Thanks for the kind words! If I can help one person become more aware of the general lack of knowledge among doctors now prescribing subs, it'll be worth all the typing. Also, awesome Petty quote!

I actually requested the high dosage, as there was evidence of anti-depressant effects at 32mg from a Harvard Medical Journal Study. Of course, at no point whatsoever did anyone ever say to me, the struggling opiate addict, "hey, lets talk about your future and how long you wanna stay on bupe". But I agree, most people have dosages that are too high. My tolerance to opiates when I came out of rehab was enormous. But that was back when one could get opana 40's very cheap, all day long. Most of my friends who have got on bupe in the past couple years, no matter how mild their habit, the doctors are immediately stared them at 8mg daily once the introduction dosages were complete. I know they started me on 24mg back in 2011, just taking my word for my tolerance and use patterns. Just nuts. Only thing I can add is that you gotta research any doctor your going to, if you have the privilege of choosing between all the md's and their PA's jumping up to be your legal bupe dealer. That's the other thing folks, not having to be dependent on someone, who has no clue what its really like trying to get clean, writing your script each month is a great thing.
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#6
laizerfiest,

How are the PAWS going? Are you having the up and down thing where you feel better one day / worst the next / rinse & repeat? Just curious---- Getting off of "maintenance" opiates is a tremendous accomplishment.

Hope you are doing well.
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#7
GOJ,

Thanks for asking! No, PAWS is still pretty bad, but i tend to overcompensate my neurochemical levels when i feel really bad. I guess im just tired of dealing with the extreme depression for a year+ before this even started. They did come and go for the first month past the acute withdrawal phase. They are slowly becoming more rare/milder. I always wanna emphasize to possible bupe patients, its hell to come off of, be careful! And take are of your self goj!
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#8
Really Great Post Laizerfiest!!  

I think it deserves a BIG Thank-You for sharing this with us...  I believe these type of posts, ones that contain a true shared experience can really be helpful to read for a lot of us here, some of which might be in a similar situation to the one you have shared with us here or maybe considering using Subutex to aid with opiate withdrawal.  I think there will be a few people that find it difficult to ask, or just don't wish to post on some topics, such as opiate addiction/withdrawal on public forums - for a whatever reason.


Also, WOW!! That sounds like it was a truly awful experience!!! Stopping Subutex at 2mg is WAY too high a dose to come off of, also you should not have been left on them for 7 YEARS in the first place! I can only imagine just how mentally and physically painful that must have been!! They are not the actions of a responsible Doctor to  let you stop at that level/dose!

From my own experience  when I used Subutex myself for opiate withdrawal,  was a good one and worked really well for me, though it was a long time ago now(Over 15yrs+)...
I was started out on 16mg daily(2 x 8mg tabs), and slowly reduced over a long period of 12 to 18 months or so. Finally I reduced it down to just 0.1mg a day(The smallest tablet available then was only 0.4mg, and was kinda awkward as I had to cut them in a pill cutter and they were oval shaped tablets then).  However doing it that way, it did work exceptionally well for me, when I came to the end I did not even need to miss a single day off from work (which was a 14 hours day for me back then, and it was a manual labour job).  So it can be a great way to come off of opiate addiction when administered correctly - I truly believe that! BUT as your post makes clear, you really need a decent Doctor and lower the dose VERY slowly over a relatively long period of time.

Anyhow, Thanks again for sharing with us and well done for dealing with your addiction so well as you did! I don't think I would have dealt with what you went through so well...

I wish you well my friend!

Smile
Do not follow where the path may lead, Go instead where there is no path...
And leave a trail... of Love, Laughter and Understanding.
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#9
Hey congrats on getting off Laizerfiest! Not an easy thing to do at all for many of us.

I wanted to point out that although my long term med was m-done, I've had a very similar experience to your last post. I still get many days of total lethargy, bowel issues and paws. All I can do is push thru and hope the days ahead will be better.

I'm at almost 19 months free now, and I'm very happy to be free of it but still waiting for my body to readjust fully. I have noticed additional exercise and maintaining a regular schedule helps greatly. Best of luck to you, and all who are recovering from our demons.

Den
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#10
Hey yall, thanks for the feedback and support, makes me feel like this isnt just me being insane or completely lazy somedays.

Izzy,
Yeah I decided to just tough it out and not pay some shill scumbag doctor $100-$300 a month in cash per visit (at least in NC) to tell me which bupe med he would give me and then send me out the door without helping anything else. I realized I'd save so much cash on better drugs than staying subs. Specially with no urges at all towards opiates. Yeah you had a doctor to guide you through it. I was also using the subutex 8mg pills, bc naloxone give me migrains. So imagine a pill the size of like a 1/4 the circle size of the apple home button. I had to try and cut that lol! Least I can laugh about it now.

Denman66,

I appreciate that kind of info, even though I gotta admit, that's fucking hella depressing. My family thinks I should have bounced back completely already! 19 months is nuts. Good for you!
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