They are freaking me out!

From a reader named Jennifer:
I BEEN READING ON OTHER WEB SITE FORUMS AND THEY ARE REALLY FREAKING ME OUT ,SAYING THE WD FROM SUB ARE WORSE THAN WD OFF THE VICODIN ,GOSH I HOPE I DIDNT MAKE A MISTAKE.

Response:
Jennifer, I’m not sure where to start with such a comment.  I guess I’ll start by letting you know that those people are simply wrong;  Suboxone is used as a detox tool all the time including by many of the big treatment centers– even abstinence-based centers.  There are a number of studies that support such use, and that demonstrate clear reduction in withdrawal symptoms when a person switches to Suboxone prior to a taper.  Studies are one thing… more important is the clinical impression that has developed from using Suboxone in such a way.
Then there are animal studies that show similar findings– less withdrawal-associated behavior (less sleep, general arousal, decreased eating, less social activity, etc) by animals coming off buprenorphine than off of pure agonists like methadone or oxycodone.

I think of the people I have had who have come off of buprenorphine– they all kept working during the period of time.  One woman didn’t know that Suboxone had withdrawal and she came to an appointment and announced that she stopped it– I said ‘didn’t you get sick?’ and she said ‘no…. was I supposed to?’  She then said that in retrospect she wasn’t feeling great for a few days and thought she had the flu.  Her comments support what I have generally seen–  that there is a ‘kindling effect’ for withdrawal from opiates just as there is from alcohol and other drugs– a sort of ‘memory’ for the withdrawal.  With alcohol, people who have the DTs are much more likely to have them with the next withdrawal episode… with opiates, people who have had bad withdrawal tend to have bad withdrawal again.
I don’t know what is behind the horror stories– I know that there is a loud methadone lobby out there that tends to constantly badmouth Suboxone, which is a bit silly– it is a rare person who has even made it through methadone withdrawal as it goes on seemingly forever!  I can guarantee you that withdrawal from Suboxone is NOTHING like that.  I also know that whenever there is something popular, there is a loud group against it.  If you really look at the posts of people saying that about Suboxone you will recognize that the comments are not from people trying to be helpful– they are comments intended to scare people.  They are also simply wrong.
I treat chronic pain with opiates in some rare cases, and have been through withdrawal myself many many times (none in the past 8 years, thankfully).  In general, withdrawal happens as one’s tolerance goes from high to low.  Since the tolerance with Suboxone is ‘static’ (meaning it stops at a certain point) and tolerance to opiate agonists is dynamic (it continues to increase indefinately), a person on Suboxone will have the same withdrawal taking it for a month as they will taking it for a year.  On the other hand, users of agonists will have worse withdrawal the longer they are using.  The other important point is that withdrawal is related to half-life to some extent;  short half-life drugs have short, intense withdrawal and long half-life drugs have withdrawal that is a bit less intense but that lasts a lot longer.  My withdrawal from fentanyl had two components, consistent with the complicated way fentanyl distributes in the body (small doses have a half-life of 20 minutes from redistribution in the body; large doses have a half-life of days because the metabolism depends on the liver).   For 4 days I was so sick I could hardly walk– legs kicking constantly, my hands numb from being so cold, severe nausea and diarrhea– then I got  quite a bit better but was still exhausted, couldn’t sleep, and had no appetite for a couple months.

There is a bigger issue to your comment though, Jennifer.  What I don’t understand is what you were trying to accomplish by taking it, and why you are going off of it.  Suboxone is not perfect– I recognize that! It does have a cost to it, and some people have some side effects.  But look at the alternative!!  Despite what you hear from the methadone lobby it is a rare person who changes from Suboxone to methadone– once a person has been in the position to go to the pharmacy once per month they don’t tolerate standing in line every morning anymore.  They also don’t like the sedation most people have from methadone.  And there are only two other alternatives– getting busy with a 12-step program or going back to using.  If you are doing the former, good for you– that is a great thing to do as there are so many other parts of a 12-step program that can improve a person’s life.  But people who stop Suboxone without a good recovery plan in place always go back to using– as surely as the sun rises in the east.  And whatever you didn’t like about Suboxone, you will HATE about using again.  You will be sick all the time, you will be broke, you will be obsessed with your next dose, you will do things you feel ashamed of…. don’t you remember?

Opiate dependence is a cancer.  Suboxone is chemotherapy.  In the early days of chemo, the drugs made people sick, made their hair fall out– but what choice did they have?  Opiate dependence is the same– the medication isn’t perfect as it is early in the game as far as developing meds for addiction.  But what is the alternative?  People will say that it is a problem to be ‘stuck on Suboxone’.  I agree– but it beats the alternatives!  Suboxone is expensive– yes, but cheaper than using!  It makes them sleepy– yes, but using made you feel 100 times worse!  The bottom line is that is stinks to be an opiate addict.  But at least now we have a medication that will stabilize things.
So Jennifer when you wonder if you made a mistake, I wonder which mistake you are referring to.
SD