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PostPosted: Sat Aug 22, 2015 9:43 pm 
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Unless you were taking small doses or were on Sub for a short period, you're far better off switching to a shorter acting opiate, instead of Suboxone. Sub and Methadone are the worst opiates long term users should come off of. I wish I would have learned this earlier. I switched to Morphine Sulfate 30mg and took that a month, and came off that. Obviously the longer you can be on the shorter acting drug the better. Hydrocodone or Oxycodone would be a good replacement too. A lot of people, even addiction experts say you're better off kicking H than a long Sub habit. Of course everyone is different, but people who are struggling with getting off Sub should try it.


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PostPosted: Sat Aug 22, 2015 10:26 pm 
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Hi Keith,

The consensus of our forum and Dr. Junig, who created the forum, is that if we were able to taper off of short-acting opiates, we wouldn't have ended up on buprenorphine in the first place. I can't imagine going back to percs, because my addiction would just rear its ugly head and I would be back where I started. Suboxone has allowed me to get my life put back together and I don't take it for granted even one small iota!

There are plenty of people who have trouble coming off opiates and we hear from them how much of a challenge it is to get off and stay off. However, I suspect that for every one addict we hear from, there are 5-7 addicts who haven't had that much trouble. There are members/addicts who taper down to a small amount, like .00125 mg a day and then step off. These are people we don't hear back from because they are busy with the new healthier focuses and better relationships with their friends and families. :)

Of course, you don't have to take my word for it. Although there are plenty who fly off, never to be seen again, some will pop back in every once in a while to update us on their lives. They may have gotten to the point where they were angry at the medication because that anger kept their motivation going to stay strong. However, now that they've gained some perspective from growing up they realize that blaming suboxone doesn't make sense. Sub is just a tool to help in certain cases. It's the addiction that we need to keep our focus on so that it doesn't return and bite us in the ass once again.

Amy

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PostPosted: Sun Aug 23, 2015 1:07 am 
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Switching to a shorter acting opiate does not necessarily mean going back to your drug of choice that you abused or enjoyed recreationally. For example my drug of choice was hydrocodone. But I switched to ms contin tablets which kept me well and away from withdrawal, but did not have that speedy euphoric element than made hydrocodone so appealing to me.

And the advice isnt just for people who are tapering off at home but also for people preparing for a medical detox. I can only speak from 14 years of using opiates. And my opinion is that there are better options for a long term sub user who wants to stop, yet not experience such a brutally long withdrawal that suboxone causes due to its uncommonly long half life and how strongly it binds to the brain receptors. Those are facts. Speculation on the percentages of people who successfully used Suboxone to kick an addiction to a weaker medication is anecdotal.


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PostPosted: Sun Aug 23, 2015 12:40 pm 
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I realize that my experience on the forum is anecdotal and that I don't have studies to back up the percentages I suggest. Dr. Junig's numbers, since he has treated 1000s, are less speculative and more substantive. However, I've never asked him if he has knowledge of people getting off buprenorphine by using short acting opiates.

Since I'm in graduate school for Addiction Studies right now I have access to awesome databases of scholarly journal articles. I just searched for the terms "buprenorphine" and "cessation". I wanted to keep it as open ended as possible. I've just read one article that claims that abrupt cessation of buprenorphine in the included case studies caused mild opiate withdrawal symptoms for one or two days, and therefore, perhaps clinicians shouldn't be as fearful of helping their patients off bupe swiftly. WHAT???? Keith, you are correct that the long half life and strong receptor affinity of buprenorphine cause withdrawal to be a daunting prospect. I'm disturbed that the conclusion of one article downplays the withdrawal symptoms associated with abrupt cessation.

Anyway, back to our subject. I didn't find any studies or scholarly articles of bupe cessation aided by short acting opiods. I would suggest from my own experience with opioids and what I've read here on the forum that what you suggest would have to be supervised by someone with clinical experience. And to avoid triggering relapse, the short acting opiate, as you suggest, would need to be one that the addict does not associate with their addiction.

My biggest concern with what you are suggesting is that the reward pathways in the brain would adapt themselves to whatever short acting opiate you choose as an aid to withdrawal. I'm not sure that the fact that morphine, for example, was not my drug of choice could provide much protection against the possibility of cross addiction to any opioid. That's why I'm saying that if bupe cessation with short acting opioids is a possibility, it would need to take place in a clinical setting. I still tend to be wary of this idea.

Amy

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PostPosted: Sun Aug 23, 2015 4:57 pm 
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I agree with Amy. Tell opiate addicts to kick their habit... with opiates!? However, if a person has been on subs for a substantial length of time, and has no desire to go back to their old ways, is just physically dependent on the sub, shorter acting opiates may in fact be easier to get off of. But even in this case, I don't think any doctor would be on board with this. It just doesn't make much sense in their standpoint, and I totally understand why it would not.

So let's say the sub user gets pills off the street to help them with sub withdrwal. Having that contact even with those individuals are going to up the chance of relapse.


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PostPosted: Sun Aug 23, 2015 5:02 pm 
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I don't think any doctor would be on board with this.

It is illegal (except for Suboxone, and Methadone in treatment facilities) to prescribe an opiate for detox or treatment. So you are right, not to many docs would be on board for this.


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PostPosted: Tue Aug 25, 2015 8:33 pm 
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I agree with Amy,Qom,& Doc.
If you really want to kick the addiction. No matter what it is. You are going to have to Square up with your brain and body eventually. I'm all for people having as much comfort as can be found during wds. But I'm not sure using short acting opiates(for a short time) would even possibly help shorten any sub wds. In my experience right now. It's not the Acute wds that were hard. Its been the onslaught of anxiety/lack of energy/cravings-(to feel better) and depression. How would using a short term shorter acting opiate help with all that? It would get me high and help. But then i come back down and then what? Maybe I'm wrong. Or misunderstand something. Wishing you all the best.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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