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PostPosted: Sun Nov 20, 2011 9:59 am 
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Hey everyone.

Considering I'm trying to build a picture about my future, what I'm going to do to get off Subs, how to do it etc. I have a question that's important to me, given I seem to metablise buprenorphine fairly quickly.

I've noticed that in myself, and from what I've read on this forum, that we all reach a point in our tapering where we start getting withdrawals leading up to our next dose, no matter how long we try to stabilise. For many people who dose twice a day, this is somewhere below 4mg daily. Say they have 1.5 mg morning and 1.5 mg evening, they have reached a point where by 5pm they start having mild withdrawals until the next dose. Same thing goes when they wake up in the morning. Further reducing makes the withdrawals kick in sooner.

At this point they may start to dose three times a day, which seems to allow some further tapering, but again people seem to hit a level where it doesn't matter how much they "stabilise", they are spending increasing amounts of the day in withdrawals as they taper. From there on, it seems that with every dose reduction, the amount of time spent in withdrawals just increases. And this makes sense, because buprenorphine's half-life depends largely on dose. It's at this point that some have Suboxone "busts" where they take a higher dose to bump up their levels and feel some relief.

A lot of people at this point seem to consider jumping off, biting the bullet, and getting the withdrawals over and done with.

I just want to know what you guys think of this, and your experiences with this. Am I off the mark? If not, what did you do to deal with hitting this "wall"? What dose was it? Did you continue your taper with discipline, or take the plunge?

The reason I ask is because of my fairly fast metabolism of buprenorphine. I can imagine that I would start getting uncomfortable under 6mg.


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PostPosted: Sun Nov 20, 2011 4:13 pm 
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During my taper I experienced withdrawal symptoms between doses, especially after I'd just decreased my dose. Those withdrawals would usually start 2 or 3 days after the decrease and go away by 7-10 days after the decrease. Then I'd be "stable" again and I'd stay there for a while before further decreases.

But even during those "stable" times, I would wake up feeling withdrawalish and sometimes have some withdrawal symptoms in the evening. I dosed twice a day for as long as I could, then when I got down to like 0.3mgs I just dosed at night. Night dosing worked for me because I could sleep better and I found it easier to deal with withdrawal symptoms during the day.

The number one technique I employed for dealing with the withdrawals was distraction. If I was busy, working, cleaning the house, doing something fun with my kid, taking a walk in the park, whatever...then I noticed the withdrawal symptoms seemed to disappear. If I sat around on the couch feeling sorry for myself, cataloging every sneeze and muscle ache...it was much worse.

Number two technique was a kind of mind-over-matter, positive attitude, refusal to be a whiny bitch about it kind of thing. When you're going through withdrawal or tapering, your mind will try to get away with some crap. Anxiety was a feature of my withdrawals so I watched for the anxiety symptoms and ruthlessly crushed it before it could get a hold on my mind. Feeling sorry for myself was another danger. How you short-circuit these things is something that I think everyone has to figure out for themselves - what worked for me might just annoy someone else. I used techniques that I pulled from many years spent in therapy dealing with my depressive disorder - CBT tools, self hypnosis, meditation, positive self-talk, re-framing situations, DBT techniques, things I learned from reading the SMART recovery website.

A big part of what it boiled down to was the story that I was telling myself. Am I a victim of a horrible disease and a crappy cure? Am I fucked over by big-pharma? Am I suffering in a totally unfair way that is beyond my ability to handle and will never, ever, end?

Or am I taking steps to move on to the next phase of my recovery? Maybe there's a different story I could tell myself. That I am in control of the speed of this taper, and I always have the option of taking a bit more Sub if I feel the withdrawal is more than I can handle. That the mental, emotional and physical effects I was feeling were signs that by nervous system was adjusting itself to less medication and that while uncomfortable, they were signs of healing. That I'd been through bouts of influenza that were much more uncomfortable, that I'd navigated through a serious mental illness and that I had enough skills to navigate this.

I'd remind myself that what I was going through was temporary and that many people suffer through much worse to treat their illnesses (like cancer, for instance). I'd remind myself that anxiety and anger weren't going to kill me and that I just needed to sit with it and let it pass or do something to get my mind off of it. And I told myself that I was awesome and kick ass and doing amazing and all of that too. Also, that I'd survived childbirth. Fuck yeah!

I also enlisted the support of my partner and just tried to treat myself well. Lots of hot baths, or I'd hit the gym and then the hot tub or the steam room. I had clonidine also, though I didn't use much of it because it was too sedating. It was useful for the first week after I jumped and for a couple of dose reductions that I had a hard time with.

I honestly think that a good part of the withdrawals are mental. The part that are really physical just won't be denied - the sneezing, yawning, goose bumps, feeling cold, etc. But a lot of the other stuff - the vague aches, anxiety, sadness, cravings - is psychosomatic. Which isn't to say it's not real...it just means it requires a different set of skills to get through it. A healthy dose of just ignoring it and getting on with life worked well for me. I found I had a far greater ability to do that then I ever realized I possessed. And it wasn't like I was spending all day feeling like crap - it comes and goes, and some days are better than others.

Ultimately I decided to jump from about .2 or .25mgs instead of spending another month getting down to .1 or less. It was August and I was starting school in September and I was going to my best friend's wedding right before that, and I just wanted to be done. So the timing was right for me and my jump really wasn't bad. Other people have tapered even lower and basically stepped off with almost no withdrawal and that's great too.

The cool thing about tapering is you get a lot of opportunities to practice all the skills you need to get through the quitting process. I recently quit smoking (again) and so many of those tools came in handy during the process. It was the easiest time I've ever had quitting smokes.

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PostPosted: Sun Nov 20, 2011 10:31 pm 
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Diary of a Quitter wrote:
That the mental, emotional and physical effects I was feeling were signs that by nervous system was adjusting itself to less medication and that while uncomfortable, they were signs of healing.


That's been key for me getting through many detoxes in the past. If I never "flipped the script", viewing withdrawal as healing rather than punishment, I would likely still be fearing withdrawal til this day, and stuck in active addiction.

It's funny you mention childbirth. While I could never understand the depth of that pain, I understand the need to remember surviving something tougher. This Interferon treatment has put tapering in perspective in my own way. I've jumped off a large-ish doses of methadone before, and I'd choose it over this treatment in a heartbeat. At least the withdrawal I know what I'm in for.

Since I've been coming to the end of this treatment, I haven't been as fearful of looking towards tapering one day. I figure if I can get through this, a slow disciplined taper will pale in comparison. But at the same time, I've been a bit cranky lately hearing people complain about Suboxone and how much it has messed them up, how bad it has made them suffer. How much I'd like to be in their position, tapering or in withdrawal, free of Hep C and its treatment, about to be off Suboxone.

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Anxiety was a feature of my withdrawals so I watched for the anxiety symptoms and ruthlessly crushed it before it could get a hold on my mind.


Show no mercy! Crush that anxiety with an iron fist, leave no bone unbroken, look around, walk away, and don't call the paramedics. :wink:


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PostPosted: Mon Nov 21, 2011 1:16 am 
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tearj3rker wrote:
Diary of a Quitter wrote:
Since I've been coming to the end of this treatment, I haven't been as fearful of looking towards tapering one day. I figure if I can get through this, a slow disciplined taper will pale in comparison. But at the same time, I've been a bit cranky lately hearing people complain about Suboxone and how much it has messed them up, how bad it has made them suffer. How much I'd like to be in their position, tapering or in withdrawal, free of Hep C and its treatment, about to be off Suboxone.


Ohmygod, I KNOW!

Addicts can be a bunch of whiny babies at times, huh? :wink:

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PostPosted: Mon Nov 21, 2011 9:37 am 
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DOQ said:

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The number one technique I employed for dealing with the withdrawals was distraction. If I was busy, working, cleaning the house, doing something fun with my kid, taking a walk in the park, whatever...then I noticed the withdrawal symptoms seemed to disappear. If I sat around on the couch feeling sorry for myself, cataloging every sneeze and muscle ache...it was much worse.


Tearj3rker: I think what DOQ said above bears repeating. When it comes to tapering successfully, DOQ's advice is the best around as far as I'm concerned.

I think most of you all know I haven't tapered yet, but I've been reading and watching people do so on this forum for over 2 years. In that time I've seen people write taper journals, from detailed descriptions posted twice daily to others who only check in once a month or so. I even started a thread on this subject. My opinion from watching all this is that the people who focus on those w/d symptoms the most frequently and the most obsessively are the ones who appear to suffer the most. Those who use the distraction and other techniques DOQ mentioned seem to have the greatest success. Of course this is only my personal, very non-scientific observation.

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