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 Post subject: Tapering & Cravings
PostPosted: Wed Oct 31, 2012 2:29 am 
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So I have been on suboxone for about 7 weeks now. I started on 16mg per day and after 3 weeks went down to 12mg. Then after 4 weeks went to 8mg/day. I kept that going for 2 weeks and then dropped to 4mg/day for the past week.

I'm on the 2mg/0.5mg films and tomorrow is my last day of 2x/day. Then I'll be dropping to 1/2 film twice a day for a total of 2mg a day for a week, then 0.5mg twice a day for a 1mg total for a week, then off, as my doctor has suggested. He actually wanted the following:

8mg: 2 weeks
6mg: 2 weeks
4mg: 2 weeks
2mg: 2 weeks
1mg: 2 weeks
OFF

But since when I started that taper I had only been on it for 4 weeks, I though that a 10 week taper sounded crazy. I got on suboxone to save me from my IV heroin addiction. Once I get off the suboxone, my sub doctor is helping me switch over to oral naltrexone or the Vivitrol (naltrexone injection) shot as soon as possible, so that I still have a blocker on board. I am on klonoping 2mg/day and we've decided that it's safer to be on naltrexone that suboxone with that combination.

My issue is that since I dropped to 4mg per day, my cravings have gone up. I'm thinking about pills more, not so much heroin because that seems dirty to me now, but it's getting into my thoughts more. I'm thinking about my old using friends more and am scared that further dropping could lead to a relapse before I get on the naltrexone. I just need some support and wondered how others have dealt with cravings while tapering off suboxone. It's tough and I knew this would happen, but I'm getting through it. My job, life, and everything is going great right now and I've got 2 months clean and don't need a relapse right now.



Thanks guys,
Caleb


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 Post subject: Yikes
PostPosted: Wed Oct 31, 2012 11:16 am 
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It doesn't sound like you are ready to get off suboxone. If you are already having old issues, how are you going to keep yourself from going back to other opiates? Detoxing from this substance its one to be trifled with. The repercussions too phenomenal.

I wish you good luck in whatever you decide. But, please, rethink this.


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PostPosted: Wed Oct 31, 2012 11:43 am 
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I agree with Brittany, I don't think now is a good time for you to be getting off of Suboxone. I don't think the reason you listed for getting off of Suboxone is completely valid either. As long as you have a tolerance to Suboxone and the benzo you're taking, you should be OK. The deaths that have been reported by combining Suboxone and benzo's happened to people who had no tolerance to one or both of those drugs. The other deaths that I'm aware of from Suboxone and benzo's happened because one of those drugs were taken via IV.

I don't think you're going to be any safer on Naltrexone, even if you go with the shot that lasts weeks or months. The problem with that route is if you do decide to try and get high, your first attempt will probably result in failure because of the blocking action of Naltrexone, the next time you try, you may up your dose of H or pain pills to try and "breakthrough" the blocking effect of Naltrexone and you may end up OD'ing.

In my opinion, you're much safer being a dose of Suboxone that eliminates your cravings and taking your benzo as prescribed.

Obviously, I'm not a doctor, this is all just my opinion.

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 Post subject:
PostPosted: Wed Oct 31, 2012 1:01 pm 
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Let me clear some things up. First off, these "old issues" aren't as bad as I may have left them open for interpretation. We all know that Suboxone helps to stop cravings and as my dose lowers, they come back. Addicts with years clean still get cravings, this is part of having the disease of addiction. And my suboxone doctor won't continue my suboxone while I'm on klonopin. I agree about how when benzo+sub is lethal in very few cases and mainly when used IV with no tolerance.

My doctor just simply says it's either suboxone, or naltrexone and klonopin. And naltrexone is a stronger blocker than suboxone is, so there's no way I would even attempt to use any opiates on it. Every single urine screen has come back clean since I've been seeing my doctor for 2 months, etc.

I just don't want to be dependent on a partial-narcotic like suboxone and prolong this dependency. I don't think I was asking whether it was a good idea or not to continue with my situation, I was simply asking for input from others if they had experienced craving increase when getting off suboxone. I mean, I would stay on it if my doctor would allow, but I can't seem to find a suboxone doctor that is ok with me being on klonopin and I don't really know what else to do. Suboxone is serving as a blocking function for me and my doctor actually thinks it's an excellent idea to switch to Vivitrol. And we both agreed that if naltrexone didn't work well, I'll be switching back to suboxone. I guess the situation is just hard with this particular doctor because he won't allow them together even though my pharmacist told me it's fine to be taking suboxone and clonazepam together. I just live in an area with not many other suboxone doctors so this is what I'm left to do.

Anyway, I understand cravings are a part of recovery and I'll have to deal with it.


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PostPosted: Wed Oct 31, 2012 4:26 pm 
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I had cravings that totally took me off guard when I went off Sub. I didn't have them at 4mg, they really only kicked in when I was off completely. I ended up having a pretty significant relapse. (I'm back on Sub now).


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PostPosted: Wed Oct 31, 2012 5:31 pm 
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How long were you on it before jumping off the first time? If I may ask.


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 Post subject:
PostPosted: Wed Oct 31, 2012 8:46 pm 
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Hey cwake.

I'm gunna take a different angle than some of the others, because I kinda agree that cravings are largely a natural part of recovery. And I think it's a positive sign that you've spoken about them here where we can at least try to work you through these problems. I also think that, while it might be scary, it's probably good that you're experiencing these feelings while you're still on Sub and have some kinda buffer against overdose. However, this might be a time to slow things down a bit. If I were in your position, I'd sit on this dose for a lil while and see how you go with cravings at the level they are now.

Naltrexone does help with cravings a tiny bit. But compared to the dose of Sub you're on now, the cravings you'll feel on an antagonist will be more intense. And just knowing that you dose will be blocked for many people isn't enough to stop them "trying". Like Romeo said, people have been known to overdose while on Naltrexone, when they take large doses of opioids to try and overcome the blockade. Sometimes they succeed, sometimes they don't. But the respiratory depression happens even if they get no opioid effect, so people have been known to stop breathing without feeling high.

The other riskier scenario is when people's injection wears off (many say they can "feel" it wear off), and they realise they can get high again, they might use before their next injection appointment or even skip it... not realising that naltrexone literally resets your tolerance to zero... it makes you even more sensitive to opioids than an opioid naive person. It is probably the highest risk of overdose in an addict's life to use after they'vve been on naltrexone, even if they've only been on it for a few days. And it's really important that a doctor stress this to anyone they put on naltrexone. Where I'm from they've been using naltrexone for a while, and even the most pro-naltrexone clinics handle it with caution.

That being said, naltrexone can be really useful. It can be a really useful aid or adjunct, like a safety net. But the only people it works for are those who don't rely on it. It should just be there in the background just in case, with the real recovery work should be all you. You can't rely on naltrexone like we rely on Suboxone. Which is why I think you should slow your taper a bit and see how you manage on these low doses of Sub. If you're struggling maybe do something else to help like meetings or posting here regularly... or even raise your dose a bit until you feel ready to reduce again... because if you can make it on low doses of sub doing a gradual taper and manage your cravings, you'll be much better prepared to make it on naltrexone.

Good luck.


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PostPosted: Wed Oct 31, 2012 10:49 pm 
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Thanks for the post.

Well unfortunately my suboxone doctor knows I'm taking klonopin for my PD/GAD and is in a hurry to get me off the suboxone because he's soooo convinced I'm going to die from taking the two together. My Walgreens Pharmacist (a PharmD) told me that it's safe to be taking the two together and it's done fairly commonly, especially with people who take klonopin or xanax with a full agonist opiate for pain like hydro/oxycodone, morphine, fentanyl, dilaudid, or opana.

Also, when I lived out in Colorado my pharmacist told me that it was fine to take Xanax with my suboxone, which xanax is a more rushing of a benzo and has caused many drug combo overdose deaths. So basically it isn't an option to stay on the suboxone a bit longer unless I cut my klonopin out totally in order to please my doctor.


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PostPosted: Thu Nov 01, 2012 2:00 am 
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You're doctor sounds ridiculously cautious.

What do you feel you need more... Suboxone, clonazepam... or your doctor? :D


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PostPosted: Thu Nov 01, 2012 2:26 am 
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I have a sub doc in the Denver metro area if you need to switch. He is awesome!!!

Amy

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 Post subject:
PostPosted: Thu Nov 01, 2012 11:01 am 
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In my experience, my worst cravings stemmed from emotions that I was uncomfortable dealing with. When I experienced those emotions, the easiest thing for me to do was turn to drugs and numb the feelings out....it's what I had done my whole life, it was all I knew. When I finally realized that my uncomfortable emotions were causing my cravings and my lapses, that's when I finally had a fighting chance at dealing with them in a healthy way. For the longest time, I didn't know (or didn't want to know) what was causing my cravings and I was doomed to keep repeating the same old behaviors.

My emotions didn't cause all of my cravings, but they did cause my most extreme cravings. Triggers, such as seeing an old drug buddy or going to a certain place in town, would also set some cravings off. Little by little, I addressed what triggers I could and took steps to stay away from those triggers. Some triggers are unavoidable, for example, that smell in the air when spring rolls around used to set me off. For me, simply being aware of these remaining triggers and acknowledging them when they hit, but not making a big fuss about it has helped me deal with them.

As far as dealing with my uncomfortable emotions, I had to just sit there and learn to take them. I was so deathly afraid of being uncomfortable that I would go to almost any length to avoid it, but that's not a healthy way to deal with things. It was tough at first to sit there and let those emotions do their thing, but after doing it a few times, you realize that the discomfort really only lasts for a few minutes. I think the more I tried beating the emotions down, the worse things got. Just sitting there and letting them do their thing seemed to make the whole process easier.

I think what you have to do is be completely honest with yourself when you feel some cravings. What triggered them? What's the best way to deal with them? What have you done in the past that didn't work, obviously, whatever you did in the past that didn't work, don't do it again.

Learning how to deal with ourselves and our addict mind isn't the easiest thing in the world, but it can be done....it just takes practice, honesty and usually an outside view helps too.

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