Starting Suboxone While on an Opiate AND Benzo

[JonathansJourney]

Hi, I’m Jonathan and have been a chronic pain patient for about 10 years ever since I injured myself. I’ve been on opiates and benzos (Klonopin to be specific) for a while. I’d love to start Suboxone, treat my addiction and dependency on these pain meds, and get my life back together…

But my one trepidation is the Klonopin benzodiazepine I take for my severe anxiety. I’ve become very dependent on this med too, and I heard it can’t be taken with Suboxone. I’m just scared that I’ll go through massive benzo withdrawal once I start Suboxone treatment. I’ve gone through it a few times before and it was pure torture
Has anyone else started Suboxone while being dependent on both opiates and benzos? What’s the usual protocol for that, and do the practitioners have a treatment to help patients get off the benzo without withdrawal?

I’d appreciate any information and advice. I’m registered with Bicycle Health, by the way. Thank you so much!

[rule62]

Most doctors do not like to prescribe two central nervous systems depressants at the same time. My first Suboxone doctor told me to stop taking my Xanax and I did, at least for a while. Moved to a different state and my doctor here doesn't have an issue prescribing both. A discussion with your doctor is the best way to go about it. They don't want to be responsible in case you stop breathing while sleeping.

Getting off benzo's is another problem. I got off my Xanax years ago when I was taking 3 or 4 a day. It's not good for the memory or overall brain health. Now I manage them just fine, taking only one per day when needed.

That's the real issue. Prescribing two CNS depressants. An honest discussion with your doctor is the best course of action.

[JonathansJourney]

Yes, that’s what I meant. I don’t want to be on my Klonopin while getting on Suboxone and I was just wondering if Suboxone makes it easier to come off benzos? Will doctors usually make it as easy and as painless as possible to taper off? I’m just scared about that part about getting on Suboxone :/

[rule62]

Suboxone won't help with benzo withdrawals. Most all medications can be safely tapered down if you go very slowly. It took me almost six months to get off of Effexor. My doctor said I wouldn't be able to do it. The first time I tried I went too fast. Same with Xanax except I wasn't on that high of dose so it only took me a few weeks. Slow and steady wins the race.

[docm2]

Standard of care is to not deny Suboxone treatment for someone that is taking a benzodiazepine. (or THC) Some will want you to taper and discontinue. I will typically stabilize someone on their Suboxone first, then start a slow taper. Tapers can take 6 months or more. Chronic routine doses of Clonazepam are not all that effective for anxiety anyway due to tolerance. I will usually get them tapered to a low dose and then continue a few doses of a benzodiazapine a month for PRN use if they have panic attacks.

[suboxdoc]

My two cents.... first, Suboxone will NOT cause benzo withdrawal. They work at completely different systems and receptors. There is NO risk of withdrawal from benzos. There IS risk of precipitated withdrawal IF you have opioids other than buprenorphine in your body at the time you FIRST take Suboxone or other buprenorphine drugs. So be off all other opioids at least 24 hours... longer if the drug is methadone.

The risk of combining buprenorphine and benzos is less than announced in articles about buprenorphine. First, realize that the risk of OTHER opioids and benzos is much more significant than the risk of buprenorphine. The real line should read 'buprenorphine rarely causes severe respiratory depression, which is the risk with most opioids. That risk, with all opioids, is magnified by benzodiazepines. But like other opioids, buprenorphine CAN cause severe respiratory depression in the presence of benzodiazepines.'

I have testified in two cases where people died from buprenorphine (both took small amounts of Suboxone). In BOTH cases, the persons -- a 22 yo man and a 15-y-o girl --- were not tolerant to opioids. One had never used opioids, and the other was just released from jail and hadn't used for several months. In both cases, they used significant amounts of benzos (which they also were not tolerant to) and then took Suboxone -- 8 mg of the man, 4 mg for the woman. Both died in their sleep several hours later.

Deaths from buprenorphine are exceedingly rare. Estimates are 20-40 people per year die from buprenorphine -- less than people who die from lightning. Yes, there are thousands of ER visits... but not deaths, and most of those visits are from drug combinations and the buprenorphine may have prevented death.

I prescribe up to 2 mg of clonazepam per day to people on buprenorphine, and I've never had close to a problem. Once a person is tolerant to either drug, the risk of a combination essentially goes away. I realize other docs have other attitudes, but you can't argue with the science. Respiratory depression is a function of opioid or benzo activity IN EXCESS OF A PERSON'S TOLERANCE. Don't let a long-term script for clonazepam cause you to avoid buprenorphine -- if your doc is Ok with it.