10 Comments

  1. Linda

    My tapering off is going well. I know l like routine so l changed my routine of taking suboxone first thing in the morning( like l have for years) to not taking at all until l feel a mild withdraw symptom then l will take a small piece of a 2 mg strip.
    I have tried and will keep trying to prolong that habit of doing that and wait out any discomfort..
    Like l stated before l use to take 14 2mg strips per month now after 6 months l am down to 3 strips per month. With my next doctor visit l will direct doctor to prescribe 2 per month.
    My goal is to be off completely by end of this year if l can’t oh well l will keep trying.
    I am going to take my time but l will succeed.

    • This blog post is the documentation. As I’ve written a number of times, there is a big difference between peer-reviewed research and internet advice. Both have their place and limitations. One cannot do a randomized, double-blind ‘study’ of the best way to taper off buprenorphine, as the tapering process is not amenable to that experimental design. Even if it were, an academic addictionologist working with residents or post-docs would not be able to duplicate the approach that I take and recommend, i.e. where I have a close clinical relationship with individuals, communicate by text or email during the process, and make individual adjustments in the process depending on circumstances.
      FDA approval is determined by a number of things beyond clinical utility. Suboxone film was not FDA-approved for induction for many years, but was used in the vast majority of inductions. Nobody is going to pay millions of dollars for FDA-approval of ‘variable dosing’ until someone makes the business decision to produce taper packs or to boost sales by recommending such tapers. I’m aware that people argue whether buprenorphine is evenly distributed in the film or whether the thickness varies across the length of a strip, but those arguments have little relevance for several reasons. First, the long half-life of buprenorphine causes one day’s blood level to be derived from several days or more of dosing, so those slight variations, if present, will have little impact on the tapering process. And second, the psychological challenges associated with tapering are as great, or nearly as great, as the physical symptoms caused by a reduction in dose of 5-10% per month.
      And of course there are many clinical approaches that are not ‘FDA-approved’. FDA approval is required for marketing of medications for certain uses, so the manufacturer cannot market or recommend taper strategies, just like the makers of gabapentin can’t market the drug for bipolar disorder even though many psychiatrists prescribe it for that or other non-indicated reasons.

  2. Locust

    Hello Dr. Junig Thanks for the info .Everything you have said in both articles has been true in my case . I enter into day 12 feeling like the worst is behind me that said I can honestly tell people I functioned through the whole process.(I jumped from 2mg and was on that dose for 5 years)I’m not going to say it has been easy it takes commitment and especially patience.I don’t feel like I’m completely out of the woods as I still feel like I’ve lost some strength especially in my legs and that could be due to my inconsistent sleep however each day I’m sleeping a little better. Again Patience ,stay busy and enjoy your senses as they come back slowly the first one I noticed was taste .But others will come back as well some might surprise you as you may not have even noticed they have been suppressed .God bless and good luck to all who plan to get off the Subs .

    • Thanks for sharing your experience. When I went through detox almost 20 years ago, the fatigue was the worst, longest-lasting symptom. It is hard to remember specific dates from that long ago, but I do remember going to the YMCA after two months and still noticing significant weakness and fatigue… and I remember feeling almost super-powered when I left treatment, after 10-11 weeks. I see similar experiences in people tapering off methadone or buprenorphine; it takes 2-3 months for fatigue to go way, for appetite and taste to return, and to regain healthy sleep. Patience, patience, patience…

  3. Timothy C.

    I was in drug rehab through the month of June for a longstanding addiction to methamphetamine and kratom (in the last 9 years I had used kratom daily for 7 of them). I also used potent heroin every day for thirty days before going to rehab.
    My addiction psychiatrist recommended Suboxone treatment immediately after being released from rehab after 25 days. She said she considered kratom an opiate because of its action, and said she thought using Suboxone was more methodologically sound with more research behind it then using kratom for maintenance therapy, especially because kratom comes from unknown sources and is not consistent in strength (I have used kratom from trusted sources for many years and could dispute this…)
    I trusted her and began using Suboxone the day I was released from rehab. I shortly stabilized at a 4mg daily dose, but the side effects really bothered me – not only the destruction of my libido, but I was getting aural hallucinations before bed that were disturbing and keeping me from sleep; the sweating was difficult to deal with; I felt I was having water retention; there were some pretty tough sleep disturbances and nightmares.
    I tapered on my own after 8 weeks of being on 4mg Suboxone. I thought I had done due diligence with an ambitious taper program, but I did it much too fast. It just didn’t feel fair to have to take a longer period to taper than I had actually been on the medication!
    I cut my dose to 2.8 mg daily in one jump, waited 7 days, then cut it again to 2 mg daily. It was a difficult withdrawal process. It has been 12 days since I cut to 2 mg and I am still having significant withdrawal effects, mainly hot flashes, restlessness, anxiety, and insomnia with a feeling of continuous tension. I expect all of this to go away eventually, a few more weeks hopefully. However, the voices and sounds I was hallucinating before bed went away almost completely, and most of the sweating is gone (except for bursts with the hot flashes occasionally, especially under stress/exertion). Sex drive seems to be at least alive, if not great, but better than dead, like it was.
    I had been planning to cut further, but I saw my psychiatrist again this week. She was unperturbed about me reducing my dose on my own. She did say she thought I should stay on the 2mg dose for at least a year before considering going off Suboxone in order to prevent relapse.
    I have personal ideas about maybe getting off Suboxone and going back to kratom, using measured doses and frequency as a maintenance medication. I haven’t really voiced these to her, as I know she would be against it. If I stay off heroin and meth, I think I’d be okay, but I can also see that this is probably mere justification to go back to kratom instead of Suboxone. Usage of that botanical medicine doesn’t seem to have the same side effects as Suboxone, although it has it’s own issues.
    I am in an outpatient program that specifically tests me for kratom (among everything else). I have not used any substances in 100 days. I will be starting at a major university in January as a junior, and have school funding tied to my success in chemical dependency therapy, so I don’t see myself using kratom anytime soon. Yet, I have some put back for some time in the future. Addictive thinking, I know.
    Hopefully my current withdrawal effects will stop eventually. I plan to stay at the 2mg dose for a while, I guess. I’m tempted to cut it to 1.8 soon, but that’s just masochistic and perhaps self-sabotage.

  4. Derrick

    I am new on this site. I am 69 years old. I smoked my first joint in 1966 and have been drinking and doing drugs pretty much ever since.
    This past year, not sure what happened but when the dust cleared, l lost my home , $70,000
    In savings, and pretty much my family. God bless my son, I am living in his basement, he is mad at me, like the rest of them, but they should be.
    I was reading what the Dr on this site ((I don’t really recall his name)is saying. I think all you people should listen to him.
    I am on Saboxone now, and things are getting clearer for me. I am slowly getting what’s left of my life together. I used to build houses, now I am working part time at Home Depot. You know what, that’s OK. I want to survive this and I think Saboxone is my way.
    I don’t understand all this crying about the withdrawals, nothing is worse than the life I was living.NOTHING. This Dr.has reminded us of this.
    I don’t really know how my story will end, but you, especially the young people should listen to this guy.
    Thanks
    Derrick

  5. JB

    Thank you so much for this forum. I appreciate the valid information, given in a professional , easy to understand way. There’s so much out there about Suboxone that is scary. I am so glad I found this forum with explanations and answers that appear to be valid and well researched.

  6. Michelle

    This is a great documentation of the tapering process. I took 4mg a day for 6 months, 2mg a day for a month, 1mg a day for a month, and then down to .5mg a day for about 3 weeks. I am currently at day 4 without subs. I didn’t sleep last night, I am extremely restless, lots of aches that I’m not used to, and my head is pounding. I’m in the worst of it.
    I do believe in myself, and my ability to kick this. I’m nervous, but excited. I feel like I have been withdrawing for over a month now, and I am so ready to be over this! I’ve been doing this on my own, as I’m not prescribed the medicine. My boyfriend is prescribed 16mg a day, and only needs 6-8mg.. I’ve considered getting my own prescription if I can’t do this on my own… i can’t risk a relapse. This was very encouraging, though. I feel pretty confident.

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