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 Post subject: any set rule ?
PostPosted: Thu Nov 10, 2011 2:47 am 
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Curious to know if there is any set guideline or rule as to how long one should be on suboxone before they start a taper? I know your life should be in a good place and all, but I'm wondering from a physiological standpoint- how long should the receptors be nice and quiet before you start tapering ?
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PostPosted: Thu Nov 10, 2011 6:52 am 
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There's really no set time or fast rule of how long one should be on sub before starting to taper. It's extremely individualized. In your case, since you've had SO damn much trouble stabilizing, I would find the right dose first and foremost and get stable on that dose and sit there, in my non-medical, non-professional opinion, for at least a month, before trying to taper down. And when I say stable for a month, in your case I mean ZERO problems between dosing and zero withdrawals and cravings. You need to give your body a chance to "catch up", so to speak, before you start "messing" with it again. Remember, for the last few months your body and receptors have been going through hell. You just haven't had a smooth ride with suboxone, and for that I'm truly sorry.

Hang in there and try to just let yourself stabilize. Give yourself some time to just be on suboxone and not worry about your dosing for a few weeks first. Then maybe start planning a really, SLOW and LONG taper. You are the master of this taper and you need to start listening to what your body needs. You are the only one in a position to do this. Good luck and please keep us posted. :)

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PostPosted: Thu Nov 10, 2011 9:08 am 
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hatmaker510 wrote:
And when I say stable for a month, in your case I mean ZERO problems between dosing and zero withdrawals and cravings.

:)


It's not often I'm more conservative than the hatmaker on this subject, but I'd go even as far as 6 months. A good 6 months stretch stable, with all drug struggles out of your mind, and then only see if you feel ready to taper.

Because your tolerance sounds so low (based on the 5mg methadone dose), I can't imagine you needing a significant dose of Suboxone. "Slow and low" may be the way to go. :D


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PostPosted: Thu Nov 10, 2011 9:38 am 
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Anita's situation is very unique and the whole story is split up into a few different threads. She tried very small doses because of the low dose of methadone she was on, but it was never enough and it turned out she was having interdose withdrawals at that dose, too. The problem was she never stabilized on that low dose of sub; she continued having withdrawals the whole time she was on that low dose. Now that she's up to 8-10 mg, she's finally starting to stabilize.

I agree one month is pretty conservative. Again, I'm basing this on the fact that she was dependent ONLY and not addicted.

Again, it's a very unique circumstance and my opinion is just that - opinion based on a rare situation that at one time left me grasping at straws.

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PostPosted: Thu Nov 10, 2011 9:55 am 
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hatmaker510 wrote:
Again, I'm basing this on the fact that she was dependent ONLY and not addicted.


That's very true. I see where you were coming from now.

Anita, hat's on the money. If you give yourself a break and take the time you need to taper, in my opinion you've got a good chance at seeing this through.


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PostPosted: Thu Nov 10, 2011 11:01 am 
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hatmaker510 wrote:
There's really no set time or fast rule of how long one should be on sub before starting to taper. It's extremely individualized. In your case, since you've had SO damn much trouble stabilizing, I would find the right dose first and foremost and get stable on that dose and sit there, in my non-medical, non-professional opinion, for at least a month, before trying to taper down. And when I say stable for a month, in your case I mean ZERO problems between dosing and zero withdrawals and cravings. You need to give your body a chance to "catch up", so to speak, before you start "messing" with it again. Remember, for the last few months your body and receptors have been going through hell. You just haven't had a smooth ride with suboxone, and for that I'm truly sorry.

Hang in there and try to just let yourself stabilize. Give yourself some time to just be on suboxone and not worry about your dosing for a few weeks first. Then maybe start planning a really, SLOW and LONG taper. You are the master of this taper and you need to start listening to what your body needs. You are the only one in a position to do this. Good luck and please keep us posted. :)


I wanna second this. Let yourself get normalized and feel okay for a while. You need to heal from the full agonists once you are stable on Suboxone. I feel strongly that it is counterproductive/dangerous to get on and off before your body is ready. It really undermines the whole purpose of Sub, because you will get w/d and your body will scream at you for your drug of choice and you will be setting yourself up. If there was a good reason to do that, then I'd feel differently, but there's no good reason. When you do decide to taper, go as slowly as you need to go to feel nothing and you can avoid all that. Don't put yourself into any kind of w/d. There is no deadline. Just take it easy. The whole thing can be much easier if you are willing to be patient.

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PostPosted: Thu Nov 10, 2011 2:03 pm 
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But you see I have read lot of stories people doing a slow wean and still struggling as those who dont wean slowly or jump from a high dose. Am referring to long time buprenorphine users. Somebody said it seems weaning only cuts out some of the acute withdrawals but why so many still struggle is because Buprenorphine generally does not have intense extreme withdrawals like short acting opiates so basically weaning down slow and jumping off from a low dose does not really cut out much, but importantly the P.A.W.S still stand no matter what. If it takes couple of years for some people to fee Subutex in us and feel very medicated then imagaine how long it can take for it to come out of our receptors and feel some normality, thats what am concerned about and how these make P.A.W.S such a struggle and have such a long duration. Somebody also said they felt their withdrawals 1 month after jumping off bup and this from someone who jumped from a very low dose 0.125 and did a slow wean to. I think taking sub daily is adding the sub correct? because of the long half life does it really do any good weaning down to small dose when infact we are still taking sub and adding the half life? or is it really true the half life decreases the lower you go? but still I would be more happy if there were not so many people complaining of withdrawals and P.A.W.S and extreme depression from bup even after a long slow wean finishing from a very small dose. Just makes you wonder is all.


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PostPosted: Thu Nov 10, 2011 2:08 pm 
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Can I ask what happens if you stablise during tapering and continue to take the same dose daily for say 1 or 2 months? for example if someone is weaning down but stays on a dose like 0.5 for 1 month even when they are stablised, then does this become a disadvantage or simply just extend the taper? is there any disadvantage by staying on a dose even when your stablised? does it mean you may need to skip and altnerate more if you continue to take the same dose when your stable during a weaning process? isn't it a case of building back the bup again? its logical one is adding the bup if they are staying on a dose for a month even when they are stable, so what can one do to undo this?


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 Post subject: thanks as always
PostPosted: Thu Nov 10, 2011 6:11 pm 
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thanks for the input - I appreciate every wise word.
Anita

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PostPosted: Fri Nov 11, 2011 3:50 am 
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I just read this Anita, and I instantly thought of what you're going through

Quote:
Naloxone:

Possible side effects include: change in mood, increased sweating, nausea, nervousness, restlessness, trembling, vomiting, allergic reactions such as rash or swelling, dizziness, fainting, fast or irregular pulse, flushing, headache, heart rhythm changes, seizures, sudden chest pain.[6]


I've felt the effects of precipitated withdrawal from both naltrexone and Suboxone, and I remember I suffered bad tinnitus, like the room was ringing / shaking, anxiety, and some other equally nasty effects, like headache, sweats etc.

I've read studies that show we can absorb small amounts of naloxone into the blood when we take Suboxone. Whether it has any activity in the brain is doubted by most doctors I've heard from. How then can I explain why people have less side-effects taking straight Subutex with no naloxone? I've also read studies that found people have 40% higher serum naloxone levels after taking Suboxone film than taking the tablet. I certainly felt some mild side-effects similar to those you're feeling when I switched to the film.

You could experiment switching to generic Subutex, or even Suboxone tablets, and see if that helps with the tinnitus / anxiety. I have a hunch it might, but I gotta warn you that this idea goes against the mainstream.

Tj.

UK-Lad wrote:
Can I ask what happens if you stablise during tapering and continue to take the same dose daily for say 1 or 2 months? for example if someone is weaning down but stays on a dose like 0.5 for 1 month even when they are stablised, then does this become a disadvantage or simply just extend the taper?


A lot of these questions are best left for another discussion. But I gotta say that there is a huge benefit to tapering off buprenorphine instead of jumping off. A person who tapers down to 0.25mg every two days has much less intense withdrawal than someone who jumps off 2mg or 4mg. I've jumped off doses higher than 6mg and yes, the withdrawals were intense. More intense than the withdrawals of my heroin habits. But those who taper to well under 1mg, on the most part, can function quite well through their withdrawals. Some even say they feel no acute withdrawals at all. There are no studies I know of that have found PAWS is any easier after tapering, so nobody can really claim one way or the other.

Half life only affects the length of withdrawal. The longer half life of buprenorphine makes tapering actually possible. It's very rare for people to successfully taper off a full agonist. I'd choose 2 weeks of mild withdrawals after tapering off bupe than a week of writhing in a sweaty bed any day.

It'd be best to reply in the other thread you started. T


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PostPosted: Fri Nov 11, 2011 8:04 am 
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Quote:
There are no studies I know of that have found PAWS is any easier after tapering, so nobody can really claim one way or the other.


I haven't seen any studies, either, but anecdotally, those people that I've watched do the "best" tapers and had the least amount of w/d had both less acute AND less post-acute withdrawals. Look at Diary of a Quitter? So it's my belief that, yes, a proper, slow taper should reduce the severity of PAWS. And I know I've said this before, but it's not just suboxone that can cause PAWS - it can happen with ALL opiates. People in recovery can have it coming to them even if they never started suboxone, just from their active addiction days.

Anita, I hope you get to feeling better soon. Let us know what dosage you do the best on and how many times you need to dose to feel best. Thinking of you. :mrgreen:

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PostPosted: Fri Nov 11, 2011 11:10 am 
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UK-LAD, when you get down in the low doses of sub the half life does not apply. It acts more like a full agonist and does not stay in your system for long like higher doses. So yes staying on a low dose for a period of time will allow you to expel the built up bupe.

Also Diary and Ladder were both on sub for a long time and both got off almost pain free after a long slow taper. I want to stress again that internet boards are extremely one sided when it comes to taper/jumping experiences. People that breeze thru and are doing good are far less likely to join a forum for support. So you are not getting the whole picture when going on peoples posted experiences.

If done slow and low you really can get off sub without too many problems.


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PostPosted: Fri Nov 11, 2011 11:45 am 
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Hey Anita,

I think tapering is your best bet. As Breezy_Ann said, DoaQ and Ladder got off Suboxone with relative ease by doing a good taper. I know Laddertipper hit some rough spots during her taper, but it was nothing like what I went through by jumping off a high dose. Some other folks who jumped off a high dose (cbk1013, substation, RsjxRsj, Brian_tx) all had some fairly nasty wd and most of us suffered from PAWS too.

I can also tell you that mg113, RainRainGoAway and one other memeber (I can't remember their screen name at the moment) all got off Suboxone by doing a taper. mg113 and Rain both felt very, very minimal wd after their taper and NO PAWS to speak of.

mg113 quit April of this year, Rain quit around the same time and they're both still doing fine.

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PostPosted: Fri Nov 11, 2011 7:11 pm 
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I wanted to add in a bit more to this topic. The way the question is worded makes it just a touch more difficult to answer - asking how long to be on Sub prior to starting a taper versus how long to be on Sub - PERIOD. Since I didn't see this come up, it seems as though if we know anything, we know that one year seems to be a solid benchmark for successful treatment. Now again, I'm not saying one year prior to starting a taper, just one year of Bup treatment. Dr. J has listed this benchmark many times and there are multiple research studies that seem to confirm it. In fact, a very good study was released and talked about this week where they were seeing over 50% success with people staying out of active addiction while on Suboxone. Unfortunately, those results really tanked when Sub was stopped - to the tune of a single digit success rate - something near 8% if I remember correctly. That should really scream volumes to everyone. Imagine having a 1 in 2 chance at success while on Bup and then less than a 1 in 10 chance at success after you stop it. That is huge. I mean it really says it all - doesn't it?

So I guess if there is any take home answer to this question, at least for me, it is this: Regardless of how long you taper or when you start to taper, you really should have been on Sub for at least one year by the day that you take your last dose. The other thing that seems to scream out - and we have had many, many people here prove this for us, once you stop Bup, your risk of relapse most certainly goes up. Even people who get into the 1 mg or less range seem to struggle with relapse. Whatever you do, you really have to be vigilant and step up your game when you decide to stop Bup. For some of us, we really need to strongly consider long-term, perhaps life-long treatment. The rest of us can certainly give it a try without Bup but the stats don't lie. It's pretty much like the divorce rate stats. For a 3rd marriage the divorce rate is about 80% or 4 in 5 don't make it. Yet, how many try; thinking their situation will be different - they will be that 20% that survive. Stopping Sub is often the same. We all want to think that we'll be in the majority that stay sober. Unfortunately, it is a minority that are able to do it.


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PostPosted: Sat Nov 12, 2011 3:03 am 
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donh wrote:
In fact, a very good study was released and talked about this week where they were seeing over 50% success with people staying out of active addiction while on Suboxone. Unfortunately, those results really tanked when Sub was stopped - to the tune of a single digit success rate - something near 8% if I remember correctly. That should really scream volumes to everyone. Imagine having a 1 in 2 chance at success while on Bup and then less than a 1 in 10 chance at success after you stop it. That is huge. I mean it really says it all - doesn't it?


Those figures aren't really pertinent to Anita's case though. Like hatmaker said, she was never actually addicted to opiates. She was taking 40mg MS-Contin, then 5mg methadone. She's using Suboxone to basically assist in tapering off her pain medications.

IMO her chances are a lot more promising than those of us who were actually addicted.


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PostPosted: Sat Nov 12, 2011 12:43 pm 
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I know some will disgagree here but I do not believe life-long subutex/suboxone treatment is at all wise. I have been on it for 6 years and I feel over medicated, in brain fog, untomivated, un-sober and basically not my real self. I believe for any long half life medications such as bup do that to a person. Yes for the first couple of years sub is all good, giving you time to sort out your life, keeping you away from other opiates and even giving you a euphoric feeling but time comes when your receptors are full up and you want out. In the last 3 years the only time I felt decent was when I took to my dose and did some excercise, but as the day wears on you feel unmotivated and low. I would rather live life off sub then on it. I just do not agree on life long treatment where bup is concerned. Your brain gets used to sub so much that you feel dsyphoric and uninterested in just about anything.

I have had no cravings when am weaning. Even at 0.5 am not even thinking of relapsing. My mind is set on getting off bup and living a life where I do not take any medications. All I want is this fog lifting so I know sub is leaving my system. Now the only withdrawals I am feeling are sweats which only last for half hour before I take my low dose. Now whether minimum withdrawals are a good thing or bad I am not so sure. Sometimes I feel I have a lot of bup within me that I cant even feel withdrawals and other days I keep thinking perhaps its because of my slow wean that is making it comfortable for me, oh excercise too. I do believe excercise makes you feel much better but would I be able to excercise when I jump off sub and in withdrawals? that remains to be seen.

Is it true if one excercises during their wean and generally that it makes for a easier jump and recovery? if so how does this work out? does excercise really have benifits when you jump off? or do you have to excercise after jumping in order to feel any difference? I would prefer to know any excercise one does during their wean can benifit them when they jump..Do you guys reckon if one works out during their time on sub and their wean that by the time they jump their endorphins are already raised and makes for a easier recovery?


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PostPosted: Sat Nov 12, 2011 1:45 pm 
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Yes most people claim exercise to be very beneficial. Everyone benefits from exercise whether an addict or not.

As you have posted everyone is different and sub affects all of us differently. We welcome your experience but please be careful to not make it sound like this is how all people on sub will feel. When explaining your experience please take care to use words such as in my experience, etc. We do not want readers to think that what you describe happens to everyone. I realize there are other's who share in your experience but there are many who have been on sub long term like yourself that are doing just fine. We have many members here that have been on sub for many years with no intent to get off that are very happy with their sub maintenance.

I am sorry you are having a hard time but if it were me I would try to stress less about it. The mind is a very powerful thing and if you are expecting to feel horrible your brain may very well increase the chances of that happening. Many members that were on sub long term and tapered off say they wish they hadn't been so scared the whole time because in the end it wasn't bad. I wish you success in your taper and a life full of sober happiness!


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PostPosted: Sun Nov 13, 2011 6:13 am 
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UK-Lad wrote:
Is it true if one excercises during their wean and generally that it makes for a easier jump and recovery? if so how does this work out? does excercise really have benifits when you jump off? or do you have to excercise after jumping in order to feel any difference? I would prefer to know any excercise one does during their wean can benifit them when they jump..Do you guys reckon if one works out during their time on sub and their wean that by the time they jump their endorphins are already raised and makes for a easier recovery?


Many here have said that exercise has helped with their tapering. Exercise is, in my opinion, the only thing that can assist with PAWS. The couple of times I went through PAWS, especially the first 6 months, one of the few times I felt comfortable / at-ease was after a huge gym session. I bulked up huge! Loved it. Sure there are medications that can bring relief of PAWS symptoms, but IMO it's not wise to continue turning to medications for life's problems in early recovery.

I don't want this to turn into an argument about pro's / con's of lifelong maintenance. But there are definitely some people for whom life long bupe treatment is necessary. People with pain issues, people with severe mental illness, and people who just can't get their life together. I do agree though that it'd be tragic for someone to remain on Suboxone if they didn't need to.

Being from the UK, I gather you have to pick up your daily dose from a dispensary / pharmacy? It's like that here in Aus, and I'll be damned if I'm saying hello to the pharmacist every day for the rest of my life.

It'd be best if you want to bring up these things, that you do it in your own thread. We've hijacked Anita's thread here.


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PostPosted: Sun Nov 13, 2011 7:37 am 
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Exercise is so very important and healthy during withdrawals because it gets one's own natural endorphins going. When one is withdrawing from opiates, that's the most important thing to do - stimulator your OWN endorphins. So it really does have a place in treating withdrawals.

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