1. 163264

    I would like to know why you think you need to be on suboxone for 6-12 months. I took Vicodin about 80mg for 10 yrs. I have been on suboxone for 3 1/2 months 1.5mg since the beginning. It works fine and everytime I try to reduce to 1mg I have very small withdrawls like RLS start so I go back. But Im starting to think after 3 1/2 months and not being able to cut back that why would I be able to after 6 months and by staying on 6-12 months I am concerned about then having to deal with withdrawl from the suboxone so I am wondering if I should go for it now. I will never go back to the vicodin that is in my mind for sure as you have spoke about. But also know I don’t want any pills going in and am very concerned that the suboxone ends being forever and thats not going to be exceptable to me. I appreciate your time and what you are doing for us. It is invaluable.

    • I wish that opioid dependence was something that went away at some point. But that is not the case. The simple fact is that people who stop taking opioids, whether through rapid detox, short-term buprenorphine, cold-turkey detox, or incarceration, tend to return to taking opioids. In studies that followed people who took Suboxone for less than a year, over 90% of the people were using opioids again within a year of stopping. I have seen many people do the same after stopping buprenorphine that I had been prescribing, or when I was med director of a residential treatment center. And every person said the same thing before their eventual relapse– they all said ‘I hated being on opioids and I will NEVER go back. Trust me, Doc– I learned my lesson. I will NEVER use again.’ Of course when I told them what I am writing to you, they all said ‘but I’m different.’ I can’t fault them for thinking that way, as I thought that myself. But my relapse after 7 years of sobriety took many things from me. I have no idea why it happened, as I HATED opioids as much as anybody.
      We all think that we are different from others. But we are more alike than different, when it comes to addiction. A couple things– if you DO stop buprenorphine, just be sure to have a safety plan in place for going back on it if relapse occurs. I strongly recommend becoming immersed in a recovery program, as that would, I believe, increase the odds for staying clean. Finally, there is NO evidence that withdrawing from buprenorphine becomes worse over time. What happens, in my opinion, is that over time people forget about how miserable withdrawal is, and so they are more surprised by how they feel stopping buprenorphine than if they were still experiencing withdrawal on a daily basis. But the way the drug works at the receptor site effectively prevents tolerance from increasing after the person adjusts to the medication over a month or so.
      Thanks for reading and for your comments, and good luck, whichever path you take.

  2. twhiston

    Just found your blog; solid content.
    In my region (NE Tenn) most docs have a consensus that Sub should be used for a fairly quick taper to get patients completely drug free. It’s a shame IMO that so many of them align their practices with this flawed thinking.
    Some users I know have done well on short-term Sub programs, but I tried twice to quit during an 18 month period and found myself in a bad way thereafter.
    My current doctor said the chance of relapse decreases incrementally at the 12, 18, 24, and 36-month period. While I don’t know what controls and such were used in the study he refers to this does make a lot of sense to me if the meds are remodeling the receptors to some degree (possible?).
    As for Sub withdraw increasing over time, I’ve also reflected on the possibility that it’s a case of being so far removed from the “real” withdrawal (as from Oxy, Morph, whatever); i.e. the body/mind forgets the hell of going through withdrawal and thus when faced with the (I believe) “withdrawal lite” of quitting subs it’s a whole new shock.
    To be clear: I’m not demeaning anyone struggling with the side effects of dropping off Sub; I have a heck of a time with it. The aches, cramps, depression, heavy emotions, insomnia and just total lack of energy is tough.
    Sadly it’s also tough where I live to find a doctor who will give anything for the stomach and sleeplessness when kicking Sub. Maybe that’s against the grain but Geez it would be nice to at least be close to functional for that week or two when letting go of the Suboxone.
    It’s been 3 years since I first started treatment, with four brief periods of attempted cessation (no more than a week or two each time). I feel it’s reasonable to see if I’m just using a crutch here or if I still *really* need this treatment, so I’m in the process of letting it go once again.
    The main reason for this decision is the fact that I’ve started being abusive with the meds. I tend to take more than prescribed to get the energy kick and end up dealing with that whole “these things aren’t working the same” crap that goes with typical addictive drug use.
    This to me is a sign that I’m off track and should have a go at med-free recovery. Guess we’ll see… any thoughts welcome.

    • You will see my comments to other posts. For several years there was some amount of debate over how long to treat with buprenorphine, but the issue has been put to rest by outcome studies– at least for those who practice with some recognition of the findings in the current literature. If you are accurate about the ‘consensus’ in your area, that’s too bad; my suggestion to the docs in your area is to read the literature about rates of sobriety after short-term use of buprenorphine, and consider changing your approach to buprenorphine maintenance and the treatment of opioid dependence. While it is tempting to practice according to what we WISH happened, it is better, in my opinion, to practice according do what DOES happen. I don’t really mean to be a jerk about it– but heck, people are dying out there.

  3. jason_kahl68

    I have had 3 cervical spinal surgeries(all at the same site) with some cord damage, not only does the surgery site hurt, walking is very painful due to my altered gait. The gait has progressed to the point I am in a wheel chair. My pain is activity based, the more I do the more I hurt.
    I have been on morphine for over a year with percocet for break through pain. When I first questioned my doctor about the danger of being on the morphine he cut the percocet in half and doubled the morphine. Not exactly what I was looking for..
    New Doctor is talking to me about suboxsone. I know I can not be on morphine for a year and NOT be addicted. Its not “mental” addiction is more a physical, I got a stomach bug and could not eat(or take meds) for a few days. I came down with a bad ass flu like symptoms I was not “freaking out” just sick.
    I rarely drink and only take meds prescribed, I even transfered management to my wife so I would not be “tempted” to begin with.
    Would suboxsone be good for treating long term pain?

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