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PostPosted: Wed Apr 12, 2017 1:49 am 
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About decade ago I first became associated with suboxone/subutex. After a couple of years of using heroin in my early twenties, a friend turned me onto the medication as means of finally getting clean. It worked like magic. I was able to get my life back, I felt great (typical side effects like constipation, some fatigue/headaches, and sexual issues aside). I was able to finish law school, pass the bar, and regain a social life. For two years I took 8mg, the final six months I took 2mg. For whatever reason, my doctor kept me on Subutex during that time. After passing the bar I decided to take a couple of months to finally get off of buprenorphine. It was hell. It took three months in rehab and another nine months of awful post acute w/d's to finally feel human again. I spent about 5 or 6 years opioid free. I never really felt right after stopping buprenorphine (I'm not trying to blame that on the medication, I just felt off). After about 3 years a very serious depressions set in that continued to grow. I tried several varieties of anti-depressants over a period of 2 - 3 years. I saw various psychologists and psychiatrists. Then I began to backslide.

I started using heroin a couple of times a week, it was as controlled as actively using heroin can be (which isn't really). This lasted about a year. It finally started to have a large negative impact on my life, so I began attending an outpatient rehab. The psychologist there insisted that I go back on buprenorphine, she felt it would be the absolute best thing for me. Remembering how difficult it was to stop, I resisted. I was able to remain clean for about 6 months before giving in again. At this point I started using daily. My life by this point had declined rapidly. In January I decided to resume buprenorphine therapy. I started with suboxone, but in the first three weeks I constantly felt awful, similar to a mild w/d with frequent severe panic attacks. I switched to zubsolv, but it made no difference. In this time I was taking 8mg (or the zubsolv equivalent).

Thinking I may be absorbing some of the naloxone, I was switched to generic subutex, again 8mg. The first few days I seemed to be doing much better. However, I started to feel minor w/d symptoms frequently within a week or so. I tried reducing my dosage, from 8mg, to 6, to 4, to 3, and finally to 2mg. At 2mg I felt the worst. For 2 straight weeks I felt like I was in a mild to moderate w/d. I decided to go back up to 3mg, and for about 4 days I felt pretty good. I thought things might be turning around, but the feelings of intermittent mild w/d returned. The symptoms I refer to are mild cold sweats, stomach issues, headaches, shakiness, insomnia, and extreme anxiety.

I've been seeing 2 different suboxone doctors, they feel for me, but have no idea what's going on. My main doctor recently told me this makes no scientific or logical sense. My addiction therapist suggested I try a different brand of generic subutex, as this has helped a few of her other patients. So far I've tried one other brand, but it didn't help. I'll be starting on a third brand later this week.

I'm at my wits end. I feel tattered; I'm unemployed, major debt, my relationship of 4.5 years is about over, extreme depression...I'm terrified with where I am and even more afraid of going through buprenorphine w/d again. What's more, I don't really want to stop the buprenorphine, I don't want to just go back to feeling as I did before using again. I was hoping the burprenorphine would work as it did the first time, it greatly helped my depression back then. It just hasn't worked this time around.

In addition to the subutex I'm taking gabapentin and lyrica, with occasional clonidine for anxiety and insomnia.

If anyone has any advice, I'd love to hear it.

Thank you for reading my long post!


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PostPosted: Wed Apr 12, 2017 8:00 am 
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Hi J, Welcome! I am so sorry that you are having such a difficult time! I am not a doctor and can only make suggestions but I wonder if you may need more than 8 mgs to start? Also, is it possible that you are clinically depressed and in need of an anti depressant? You didn't say why you are taking the Lyrica? Hopefully, one of our very knowledgeable Doctors will be here with a much more educated response soon. Again, welcome!


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PostPosted: Wed Apr 12, 2017 9:32 am 
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Sounds like a really difficult time. It also sounds like the typical progressive and relapsing nature of opioid and heroin addiction. I'd be wary of blaming your period on buprenorphine for your feeling not-quite-right during your periods of abstinence. I personally believe if we felt 100% right in the first place, we probably wouldn't ever have gotten hooked into opioids. Even people who quit smoking often claim they feel like something's missing for a very long time. It gets easier, but I don't think it ever goes back to how things were.

2mg's sounds sub-optimal for maintenance. Can you get back on brand name Subutex at a higher dose? Seemed to work for you.

Depression is a common trigger for relapse. I've relapsed after experiencing serious depression more than once. My depression is also difficult to treat with current go-to medications. Have come to realise that the key to me working through these periods without running to relief is to have a degree of acceptance about them, that it's okay to be depressed, that it's okay to not be able to function like everyone else at times. If it means working less, reducing my study load, not socialising as much, that's okay. Dunno if that helps you in any way.


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PostPosted: Wed Apr 12, 2017 9:50 am 
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Thank you both for your sympathetic and quick replies.

The lyrica, gabapentin and clonidine are for anxiety and insomnia. I take them all in the evening as that is when my anxiety is at it's worst, and of course to help treat my insomnia (1200mg of gabapentin, 150mg of Lyrica, and .05mg of clonidine).

As I mentioned, I don't blame buprenorphine for my not feeling right during my opioid free years, I just felt off. I think my initial period on Subutex helped treat an underlying depression that grew rapidly during my opioid free time.

I wish they still produced name brand Subutex, unfortunately they have stopped. I have read numerous anecdotal testimonials regarding the substandard quality of the generic forms. One company, TEVA, apparently made a good one...they too have ceased production. Luckily, I found a wonderful pharmacist who is looking into all of this for me in an attempt to find a brand that works. So far I have tried Mylan and Actavis...starting tomorrow I will be taking Roxanne.

I've also read about something called "phantom withdrawals." Perhaps that's what I'm experiencing (although the symptoms feel very real). I am in the program, and do my best to distract myself when these feelings of w/d come on. Maybe in time things will improve...or maybe I do simply need a larger dose. I've decided to go back up to 4mg for now.

Thanks again!

Edit: Forgot to add, I have tried numerous anti-depressants, upwards of 12 or more. They either had no effect, or in a few cases, made things worse. I know there are more out there, and I'm willing to continue to try, but I'd like to get a handle on my buprenorphine situation first. I don't want to confuse which meds are causing what. However, I appreciate the suggestion.


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PostPosted: Wed Apr 12, 2017 12:53 pm 
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Hey all, Ya, brand name Subutex aka plain buprenorphine is no longer offered in the US. Its my understanding that brand name Subutex IS still manufactured and sold In the UK, Europe and per TeeJay's comment maybe where he lives in Australia too.

JSubutex, So sorry this all has come your way and life is difficult. It sure sounds like you're having a difficult time. I wish I had some ideas. I do think a higher bup dose trial is worth it. We do know that under the ceiling dose which seems to be 4-8 mgs, bup becomes shorter acting and folks do feel WDs. Wishing you my best today and sorry this is all so hard, P

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PostPosted: Wed Apr 12, 2017 3:33 pm 
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Hi and welcome to the forum! I don't have more answers for you, because the previous posters have done a great job.

I do have to ask a question though. Please know that I am not being a jerk with this question. I just don't understand. Why, when you started to feel withdrawal symptoms, why did you drop your dose repeatedly? That doesn't make sense to me. If you are feeling withdrawal symptoms, why don't you try 10mg or 12mg instead? I know that you are fearful of tapering down and withdrawing. (I have to mention that we have lots of people who have done long, slow tapers without much in the way of withdrawal symptoms.)

If you're going to be on buprenorphine, why not be on an amount that is a working dose for you? You seem to approach buprenorphine conservatively and with fear. My suggestion is that you experiment by adding a few milligrams to your dose instead of subtracting. You could be a fast metabolizer of opioids, which can be checked, by the way.

I wish you the best as you are dealing with this and I hope you can find a solution.

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PostPosted: Wed Apr 12, 2017 4:25 pm 
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Fair question. More background: in my previous experience with subutex I felt much better on 2mg than I did on 8. Side effects lessened, and felt better overall...emotionally, physically, etc. When I was having a great deal of trouble at 8mg, my doctor recommended I try reducing the dose...

This time, I did begin to feel better as I reduced the dose, after I stabilized. It was pretty easy to get from 8 to 4. Meaning 4mg didn't bring any more w/d symptoms than 8 did, and I saw fewer of the typical side effects. It wasn't until I got down to 2mg that things felt worse than they did at 8mg. So at first reducing the dose seemed to improve my situation.

Yesterday was my first day back at 4mg, and I think I saw some improvement, despite last nights total insomnia.


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PostPosted: Wed Apr 12, 2017 6:52 pm 
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JSubutex wrote:
Fair question. More background: in my previous experience with subutex I felt much better on 2mg than I did on 8. Side effects lessened, and felt better overall...emotionally, physically, etc. When I was having a great deal of trouble at 8mg, my doctor recommended I try reducing the dose...

This time, I did begin to feel better as I reduced the dose, after I stabilized. It was pretty easy to get from 8 to 4. Meaning 4mg didn't bring any more w/d symptoms than 8 did, and I saw fewer of the typical side effects. It wasn't until I got down to 2mg that things felt worse than they did at 8mg. So at first reducing the dose seemed to improve my situation.

Yesterday was my first day back at 4mg, and I think I saw some improvement, despite last nights total insomnia.

i feel better on 2mg (suboxone) as well, but i started out at 16mg. i agree you may need to start a lot higher then go down from there once you feel stable. are you also going to therapy? what about vivitrol shot?

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PostPosted: Wed Apr 12, 2017 8:04 pm 
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I continue to see the therapist who first recommended I go back on buprenorphine. She is the individual who first suggested I seek out other generic brands of subutex, as this may make a difference.

On an unrelated note, I know my situation/story is a bit complex, I hope I'm not confusing the issue for anyone reading my posts. At 8mg I would feel intermittent w/d symptoms, over the course of a couple of months I tapered to 4mg. During this taper my situation seemed to improve a bit, though never truly "stabilized" (I realized I used this term in my former post, but I meant it in relative terms). The improvement could be due to the lower dose, or, as I'm starting to suspect, it could be just be that I was adjusting to the buprenorphine. The taper from 4mg to 2mg was much more difficult, with 2mg being untenable for now.

I find myself back at 4mg today. I'll see how this goes, and as some here have suggested, perhaps raise my dose a bit more if necessary. My worry is that every time I raise the dose, I may feel some relief for a few days, until my body becomes accustomed to the new, higher dose, then the intermittent w/d symptoms return. That seemed to happened when I went from 2mg to 3mg, so far it's only been two days back up to 4mg.

Thank you all again for your kind replies.


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PostPosted: Wed Apr 12, 2017 8:26 pm 
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I'll share my thoughts for what they're worth.

As an attorney, you realize that there is a huge difference between what the general public believes about the legal system, vs. the actual system. You are likely frustrated when you hear people argue that evidence obtained through illegal searches should be used to convict a defendant. You know why evidence 'from that tree' needs to be dismissed. I come from a family of lawyers, btw-- dad, brother, and son. You also know that there are probably a few DAs out there who would use that evidence regardless of the legality of the search that obtained it.

The same is true with medicine. There are correct and incorrect interpretations of symptoms. I would stick with the person who argues whether your symptoms are physiological possible or not.

There is a large psychological factor to somatic symptoms, and an even larger contribution for symptoms related to addiction and withdrawal. People can have withdrawal symptoms purely because of psychological factors. Withdrawal experiences can be remembered, and replayed after a number of cues. It is common for a person to have sweats caused by opioid effects, and then have those sweats trigger all sorts of other symptoms, that 'feel' like withdrawal. Those symptoms are VERY common.

Nobody can figure out whether his/her symptoms are psychological vs. physiological. To the person with the symptoms, they feel exactly the same. So if you truly want to get to the cause of symptoms, the only accurate way is to look at the science.

There is no difference between generic formulations beyond impressions based on mostly-unconscious thoughts about the size, shape, or taste of the tablet, or perhaps the music that played in the background when you first read about that specific manufacturer. Molecules are not products that vary from 'craftmanship'. Water is water. And buprenorphine is buprenorphine-- period. Excipients are the molecules added to bulk up certain pills, and there is a slight variation in the composition of those excipients from one tab to the next. But note that you don't get sick from one form of ibuprofen vs. another form-- or from one form of amoxicillin vs. another... or from one form of melatonin, or tylenol, or lexapro, or table salt. A molecule of buprenorphine is always a molecule of buprenorphine.

Likewise, there is truly no difference 'coming off buprenorphine' vs. coming off any other opioid. People often write about one drug causing more withdrawal, or causing worse PAWS, than another opioid. Any scientist knows that such a concept is utter nonsense. The 'flaw' during withdrawal is a high opioid tolerance. The cause of that high tolerance has nothing to do with anything. I don't usually argue that point, because people will always believe what they want to believe. But your brain and body don't know, and don't care, which opioid raised your tolerance!

You will do what you choose to do, of course. But I'll tell you how I would address the issue, as a person trained in the science of neurochemistry, psychiatry, and anesthesia. I would assume that my PERCEPTIONS about symptoms are incorrect, unless I can PROVE that there are reasons for them to be correct. That is how I live, and how I interpret my own experiences. I've seen, over and over, how people are blind to things that are obvious to everyone else-- and I assume that I'm just as blind. I've seen patients with no pathology experience blindness or paralysis that is eventually proven to be conversion disorder-- and I know that they truly believed they were blind or paralyzed. And I've seen many people who repeated behaviors that kept them stuck or miserable, believing they were acting in their own best interests when in reality they were punishing themselves. And again-- I assume that I do that too.

I suggest that you keep an open mind, that something is going on other than a problem with the manufacturer of a certain molecule. What is the chance that almost every other human can take a certain form of a medication, but you can't? If that was true, the difference in your body would have shown up by now in other ways. If you lived in a space suit, for example because every contact with certain chemicals made you sick, then I'd say maybe one type of generic is better than another. But 'not feeling right', specifically related to this one medication, just doesn't make sense.

I've written so much that I am probably going to repeat myself... but I also note the vagueness (and subjectiveness) of your symptoms. You feel 'off', or depressed for example. I feel 'off' every other day! If I wake and have the thought that I'm 'off', then I will immediately feel off! And nobody ever has a clue about why he/she is depressed. If a person comes in and says 'Im depressed because of X', then the one thing I know is that X is NOT the problem. People don't become depressed about things that they can see; they only become depressed by the things they don't want to recognize or realize. Psychiatrists discuss 'defense mechanisms' or 'reaction formation' as ways that people keep themselves in the dark. For example, a person who works hard to become a lawyer, but has an unconscious fear or perception holding him/her back from giving his all to that field, will believe that something else is holding him back-- something other than the real reason. That's just how human minds are wired.

A couple final thoughts. Once buprenorphine is in your bloodstream, it leaves at a certain rate-- that has nothing to do with the medication that put it there. Your dose of buprenorphine will wear off at the same rate, whether you took generic or brand. Also, most companies use the same excipients (the substances added to bulk up the active substance). Again, medications are NOT 'crafts'. They are not furniture that one person makes better than other. Buprenorphine is ALWAYS the exact same molecule, in any tablet or capsule. The FDA makes sure that buprenorphine is, in fact, buprenorphine. If it wasn't, the manufacturer would be liable to complete destruction with the first plaintiff motion.

Bottom line-- there is so much nonsense about medicine out there. But there IS truth. Find a good doctor, like the one who pointed out what makes sense and what doesn't make sense. The others are charlatans.

Addendum: I just saw your last post... that's what I would focus on. Get on a dose that is higher than the ceiling threshold, and get tolerant to it-- and then assume that all other feelings about depression, being 'off', etc are psychological, probably based on shame, fear, or cravings. I'll check back-- good luck.


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PostPosted: Wed Apr 12, 2017 10:18 pm 
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Thank you for the long and well reasoned reply. Your final piece of advice is the path I'm on.

I wouldn't have thought the brand of buprenorphine to be the problem if someone hadn't suggested it to me...and we all know the power of suggestion. Although, frankly, if that suggestion ends up having a positive effect on my state once I switch brands, I really won't care what the cause (placebo or not). I'll take the subjective net positive and move on, haha.

I think things have improved. I'll see how 4mg treats me, and if I need to, I might bump it up to 6.

Thank you all again, your replies really help.


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PostPosted: Wed Apr 12, 2017 11:47 pm 
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Just remember that "higher than the ceiling threshold" can be above 8mg for some. Just keep an open mind about it.

When I was inducted I was given 4mg every 2 hours until I said, "Wow! I feel so much better!" I was on 60 to 100mg of oxycodone per day before my induction. I didn't say, "Wow! I feel so much better!" until I was given 3 doses or 12mg. I don't know if I passed the threshold at 10mg or 12mg, but I do know it was higher than 8mg. Yours could be too!

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PostPosted: Thu Apr 13, 2017 11:31 am 
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Depression and anxiety can be every bit as debilitating as addiction. I suffered a bout of major depression after being stable on 12 mg of suboxone for years. I was also on 2 antidepressants before I slid into the depressed state. I attended day hospitalization followed by several years of individual therapy to get my self stable. I can just imagine all of the negative self talk that you are subjecting yourself to. It does not help, you need to treat yourself kindly. In my opinion, it is likely that when you get your mental health problems addressed, the buprenorphine brand, dose, etc. will sort itself out.
It sounds like you are a hard worker, so have the ability and drive to conquer your current situation, and when you do, watch out world! I am now free from clinical depression and stable on 2 mg a day of generic buprenorphine naloxone. I think that I have been on all of the brands and made them all work. I just had to learn how to use each one. Some take longer to dissolve and some have more or less flavoring. Remember the medication only works when dissolve in your saliva. I try to keep the solution in my mouth for as long as I can before swallowing.


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PostPosted: Sat May 06, 2017 8:48 pm 
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JSubutex wrote:
About decade ago I first became associated with suboxone/subutex. After a couple of years of using heroin in my early twenties, a friend turned me onto the medication as means of finally getting clean. It worked like magic. I was able to get my life back, I felt great (typical side effects like constipation, some fatigue/headaches, and sexual issues aside). I was able to finish law school, pass the bar, and regain a social life. For two years I took 8mg, the final six months I took 2mg. For whatever reason, my doctor kept me on Subutex during that time. After passing the bar I decided to take a couple of months to finally get off of buprenorphine. It was hell. It took three months in rehab and another nine months of awful post acute w/d's to finally feel human again. I spent about 5 or 6 years opioid free. I never really felt right after stopping buprenorphine (I'm not trying to blame that on the medication, I just felt off). After about 3 years a very serious depressions set in that continued to grow. I tried several varieties of anti-depressants over a period of 2 - 3 years. I saw various psychologists and psychiatrists. Then I began to backslide.

I started using heroin a couple of times a week, it was as controlled as actively using heroin can be (which isn't really). This lasted about a year. It finally started to have a large negative impact on my life, so I began attending an outpatient rehab. The psychologist there insisted that I go back on buprenorphine, she felt it would be the absolute best thing for me. Remembering how difficult it was to stop, I resisted. I was able to remain clean for about 6 months before giving in again. At this point I started using daily. My life by this point had declined rapidly. In January I decided to resume buprenorphine therapy. I started with suboxone, but in the first three weeks I constantly felt awful, similar to a mild w/d with frequent severe panic attacks. I switched to zubsolv, but it made no difference. In this time I was taking 8mg (or the zubsolv equivalent).

Thinking I may be absorbing some of the naloxone, I was switched to generic subutex, again 8mg. The first few days I seemed to be doing much better. However, I started to feel minor w/d symptoms frequently within a week or so. I tried reducing my dosage, from 8mg, to 6, to 4, to 3, and finally to 2mg. At 2mg I felt the worst. For 2 straight weeks I felt like I was in a mild to moderate w/d. I decided to go back up to 3mg, and for about 4 days I felt pretty good. I thought things might be turning around, but the feelings of intermittent mild w/d returned. The symptoms I refer to are mild cold sweats, stomach issues, headaches, shakiness, insomnia, and extreme anxiety.

I've been seeing 2 different suboxone doctors, they feel for me, but have no idea what's going on. My main doctor recently told me this makes no scientific or logical sense. My addiction therapist suggested I try a different brand of generic subutex, as this has helped a few of her other patients. So far I've tried one other brand, but it didn't help. I'll be starting on a third brand later this week.

I'm at my wits end. I feel tattered; I'm unemployed, major debt, my relationship of 4.5 years is about over, extreme depression...I'm terrified with where I am and even more afraid of going through buprenorphine w/d again. What's more, I don't really want to stop the buprenorphine, I don't want to just go back to feeling as I did before using again. I was hoping the burprenorphine would work as it did the first time, it greatly helped my depression back then. It just hasn't worked this time around.

In addition to the subutex I'm taking gabapentin and lyrica, with occasional clonidine for anxiety and insomnia.

If anyone has any advice, I'd love to hear it.

Thank you for reading my long post!



I think I can lend a hand here. Fall/Winter of 2016 I was in the darkest period of my life just like you described. I lost my job (not due to use, but probably as a side effect of use), extreme debt, bills lapsed, let me driver's license lapse and had to retake the written/driving tests to get it back so I was driving with no license and no registration, etc etc. My #1 stressor was this habit, as it was escalating to cover up this stress of the darkest period of my life, and again it was also my #1 stressor so I was basically using opiates partly to cover up the stress from using opiates.

I looked at my life, realized I needed to turn it around, and #1 was quit the habit, went on subs, 45 day taper, now day 11 off everything and feeling pretty good. Made it to the other side, hoping to stay on the other side. However, my first 2 weeks on subs were really bad mentally. The physical symptoms gone, but debilitating depression/lack of motivation. Waking up, those thigns weighed on me - massive debt, no income, lost job, needing to get thru this taper, restarting EVERYTHING to get my drivers license back... etc. I turned a real corner 2 weeks in, dunno if it was the body adjusting to subs, or that is when I seriously started crossing that stuff off my list - got my financials shored up with a interest free cc loan, got my license back, etc. I think I really got to the core of the mental stuff that was driving my opiate use... and once those dominoes started falling was the same time I turned a massive mental corner. Coincidence? Who knows.


YOu speak of your depression, and you are blaming sub formulations.... but looking at your situation reminds me of mine.... recent job loss of a very good job, spiraling debt, crumbling long relationship... etc. Could it be that the stress/mental/mood aspects from all these stressors are really driving all the other symptoms? Anxiety and depression go hand in hand, ppl with one usually have the other, and both worsen and improve together. As your life was crumbling, back on the habit, etc.... were you caught in a cycle of using to escape from the stress, and perhaps now the subs don't provide that euphoria to cover up the stress?

It seems to me like anyone with your problems - money, job, relationships all going nuclear at once.... anyone dealing with those issues are not gonna be well mentally.... Just imagine your friend what his demeanor would look like, his outlook on the world, even his sleep habits... if all that stuff was weighing on him. Again, I too went thru those exact same issues - money/debt, losing job, still missing a girl I had seen a year ago (not anything like a 4.5yr relationship but still), etc but my story is different in that those stressors are what made me decide to start on subs. The subs didn't provide that euphoria the opiates did... so those stressors were still weighing on me those first 2 weeks on subs, but after those 2 weeks I was physically better enough to start crossing stuff off my list and that is when I also started feeling really better on subs coincidentally or not.

Again, my end point being, have you considered whether the true problem here is not the substances, but the huge life stressors going on that puts you in a place where a substance that doesn't get you high like sub can't cover up like the re-escalation to daily H did?


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