A question from a reader:
I have been taking oxycontin 40mg 4 years and want to quit so went to dr and gave me 12 suboxone 8mg took one 8mg yesterday at 3pm which would be 20 hrs after last oxy i was having serious withdrawals 10minutes after taking the suboxone i felt so nice freezing cold went away and so pleased, it is 10am and still no chills, is it possible the suboxone is out of my system now? should i still follow the dr’s calender?

My Response:
There are at least two points I want to make.  The first is a direct answer to your question:  no, the Suboxone is not out of your system.  You still have considerable withdrawal in front of you, and you are being kept from withdrawal by the long duration of action of the buprenorphine in Suboxone.

You are used to taking 40 mg of Oxycodone;  Suboxone has a ‘ceiling effect’ that occurs at a dose of 2-4 mg, and which is equal to about 60 mg of oxycodone.  So when you took the Suboxone, if felt pleasant– as if you had taken a 72-hour, 60 mg oxycodone tablet.

There is no free lunch;  your tolerance has to come down to zero, and the reduction of tolerance is always associated by symptoms of withdrawal.  You can yank the tolerance down instantly by taking naltrexone, and being very sick for a few days…. or you can taper yourself down over months, and have tiny amounts of withdrawal every day for the whole time.  But the total amount of misery will be the same.  Suboxone will not reduce that misery.  If only that were the case!

Much more important, though, is that taking a few Suboxone is no way to end a four-year addiction to opiates.  People who take Suboxone for a few days, a few weeks, or even a few months tend to relapse back to whatever they were using before the Suboxone.  And why not?  There is nothing therapeutic about Suboxone as far as treating addiction;  it will hold addiction into remission, but will not cure it.  The goal is to take the Suboxone long enough to do a couple things;  the first is to develop some real life changes, some new friends, some hew hobbies, new habits… and get things moving in a positive enough direction that the person cannot imagine going back to the former using world.

The second and more important thing is to ‘extinguish’ the conditioning that has occurred from the use of opiates.  And that takes time– more time than a few months.

I really think that people should plan on taking Suboxone for six to twelve months.  At that point, decide what you want to do… stay on it if you are still at risk of relapse, or if you have no big reason to stop it, as in my opinion it is the safest place for an opiate addict to be.  On the other hand if you really have a thing about being ‘totally clean’ for some reason, or if you are having side effects, consider tapering off Suboxone.  Realize that doing so will put you at risk, particularly during the time you are doing the taper.  That doesn’t mean it is impossible– just that you will need to be smart.  And in my opinion, the smartest thing to remember should you go off Suboxone– is that a ‘clean person’ always knows his limitations.

I guess I started this post with a title about a misguided doctor.  I will admit to being a bit annoyed.  Opiate addiction is a nasty illlness, and this is not the place to play around with things that we know do not work.  Suboxone can be used short-term as part of a tapering process at the start of residential treatment… but giving a few Suboxone tablets to an opiate addict is not going to accomplish anything, and anyone prescribing the medication should know better.


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