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My suboxone taper and advice
  1. #1
    Gurgi89 is offline New Member
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    Default My suboxone taper and advice

    Just posted this elsewhere, just trying to spread it around so people can see it, hopefully someone will find it helpful!

    I have successfully completed my taper from suboxone/subutex and I felt like sharing my experience and some of my thoughts so that they might help some people to break free from opiate addiction.

    Very brief history of my use - Active addiction: about 18 months, using oxycodone, morphine, >>>>>>, fentanyl, hydromorphone etc. Was an intravenous user. Went onto methadone program for about 2 years then tapered down and swapped to suboxone. Tapered suboxone over about 6 months. Now clean.

    No point going into it any more than that, if anyone has any questions though I am happy to answer them.

    The first thing I will discuss is the technicalities of the taper. I am not a doctor or a pharmacist, all my knowledge is from the internet/books etc. I try to cross-reference information but don't claim to be an expert, the following information is just my personal understanding of things.

    When I swapped from methadone to suboxone I stabilised on 8mg, higher than I had anticipated but that's how the cookie crumbled. It took me a few months to get used to the suboxone, I believe due to its partial agonist activity as opposed to the full agonist activity of the methadone. It felt a lot different to be on, I was less sedated and had less 'euphoria'. Overall I didn't like the suboxone, I never felt quite right on it and this may have made coming off it easier, I'm not sure.

    I will write my suggestions which come from my own trial and error experience with the taper. This is what I found worked the best after buggering it up a few times.

    These are the dose reductions from 32mg, in case you are on a higher dose like that.

    32mg 14mg 1.2mg
    30mg 12mg 1mg
    28mg 10mg .8mg
    26mg 8mg .6mg
    24mg 6mg .5mg
    22mg 4mg .4mg
    20mg 3mg .3mg
    18mg 2mg .2mg
    16mg 1.6mg .1mg

    Now it will become apparent that the smaller doses are harder to achieve with suboxone strips, and if possible you should switch to subutex when you get below 2mg. It is my belief that 2mg/day of buprenorphine is far too high a dose to jump off. For 3mg use one and a half 2mg strips. It isn't too hard to break subutex up into small pieces, in the end you will be taking one eighth of a .4mg tablet, I didn't find it too difficult to break it.

    So the doses are pretty self explanatory, in my opinion the higher your dose is the more you can reduce it by, so reducing from 32mg straight to 26mg for example shouldn't be too difficult.

    Now in terms of how long you want to stay on each dose to stabilize, this is my theory:

    The mean elimination half-life of bupe is 37 hours. Here is a small description I found:

    By definition, the plasma concentration of a drug is halved after one elimination half-life. Therefore, in each succeeding half-life, less drug is eliminated. After one half-life the amount of drug remaining in the body is 50% after two half-lives 25%, etc. After 4 half-lives the amount of drug (6.25%) is considered to be negligible regarding its therapeutic effects.

    So if we take the 37hr half life and multiply by 4 (the number of half lives it takes to reach a negligible therapeutic effect) we get an idea of how long it takes one dose to clear the body completely. 37 x 4 = 148. 148/24 (to get that in days) = just over 6 days.

    My interpretation of that information is as follows: If I am on 8mg a day of bupe I am really taking 8mg a day plus what was left in my system from the previous 6 days. Each dose has a cumulative effect due to the extremely long half-life. This effect only plateaus at around day 6 when the initial dose is leaving the system.

    How does this apply to reducing? My theory is that If you drop from 8mg/day to 6mg/day (just an example) then it takes roughly six days for the drug to reach its new, lower steady state. My own experience supports this. Once this new level is reached in the body, it took me personally at least three days to really settle into it, to let my brain chemistry adjust. So I would say that 9 days is the bare minimum to stay on each dose. Of course your mileage may vary and I can only speak from my own personal experience.

    Now I say that 9 days is the minimum, personally I stayed on each dose for 10-14 days, depending on how I was feeling. If you don't give your body time to adjust to each and every drop in dose then you get a snowball effect of withdrawal symptoms that follows you all the way down and eventually overwhelms you. This happened to me on my first attempt, I had to take my dose back up and methodically reduce in accordance with the plan I had set out.

    Now some of you may be thinking (especially if you are on larger doses) holy >>>> that's so >>>>ing slow, it's going to take forever. All I can say is that yes it seems slow, and it requires a huge amount of patience and persistence. Whenever I would get frustrated and start toying with the idea speeding things up or just jumping off I would say to myself one thing: I'm only going to do this once so I'm going to do it right.

    I was very lucky to be dosing at a pharmacy and that my prescribing doctor allowed me to have six take aways a week. This obviously made dividing my doses into smaller amounts a lot easier. I don't really know what to say to people who don't have this option, other than try to stick to the plan as closely as your situation will allow.

    In terms of withdrawal symptoms, this taper won't be entirely painless, that in my opinion would be impossible. However if you really stick to the the plan then any symptoms should be manageable.

    Other medications can be used to address some of the symptoms of the reduction, personally I used amitriptyline to help me to sleep, I went briefly onto escitalopram to manage the anxiety I was getting from the withdrawals. Other than that I would stay away from anything habit forming like benzos, unless they are only used briefly. The one situation benzos may be appropriate for is the final jump from .1mg to 0mg, but I wouldn't use them for more than maybe five days. Other than that I used paracetamol and ibuprofen for pain, I also found steaming hot baths to be helpful for those deep agitating aches that opiate withdrawal causes. Oh I also sometimes used promethazine to help me sleep.

    Basically just medicate your individual symptoms in consultation with your doctor.

    I guess that'll do for now, I'll post this much and check up a bit later, I might have thought of some more things to add.

    Please feel free to ask questions or, if you are qualified, to weigh in on any of the chemistry related things, obviously I just want this information to be as accurate as possible.

    Good luck everybody, let me tell you that getting clean is 100% worth the (temporary) pain!!!

    (edit) Just adding some other things now that I've had time to think. I don't know if it's better or easier to come off bupe than methadone, some people claim it is whilst others disagree. The reason I bring this up is because you might have read this and thought to yourself "Well this is useless because I'm not taking buprenorphine, I'm on methadone/morphine/oxys/whatever." I can't speak from direct experience but I believe regardless off the drug you are on you should be able to use the basic principles of this taper plan and apply them to your own situation (except maybe for >>>>>> as it is impossible to accurately gauge dosage).

    So...
    1. Find out the half life of the drug you are taking and multiply that by 4 to get a rough idea of the total elimination time (in days) from your system.
    2. Add at least three days and up to seven days to this number to give your body time to adjust
    3. Decrease in small increments e.g. for methadone you would reduce 5mg at a time until you got to about 20mg then drop in increments of 2.5mg. Or for oxys you would decrease 10mg at a time until you got to around 30mg maybe, then 5mg increments with perhaps some 2.5mg increments at the very end.

    One thing I actually forgot to add is that I was finding it really difficult dosing only once a day when I got down to below 2mg, as I was aching at night and couldn't sleep. I have a history of chronic pain so it might've just been me. To solve this I split my dose into two halves, one in the morning and one at night. That's why it says above that I was breaking the .4mg subutex into 8 pieces!!!! Doh!

    Ok, that'll do for now. Peace people.

  2. #2
    Randy35 is offline Platinum Member
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    Welcome!

    Here's the link to the sub therapy plan that has produced success stories out of thousands of members here. Yes, thousands.

    https://www.drugs.com/forum/suboxone...apy-66109.html

    This plan just pain WORKS!!!

    Yes, we get some of our information regarding subs from the internet and books. But for the most part our info, suggestions, and advice comes from personal EXPERIENCE!!! There are at any given time hundreds of members here recently induction, in the process of tapering, or just about ready to jump that provide their stories in these personal threads.

    If it took you MONTHS to bnecome stable after your induction you were definitely doing something wrong I'm afraid. Successful inductions usually take a few HOURS and not months!

    The half life of sub (buprenorphine) is between 24 and 72 hours. 36 - 37 hours is the average half life. It varies in all of us depending on metabolism rates.

    Jumping from any dose higher than .5mg (1/2 of 1 mg) is just asking for tough wd symptoms. We find the lower you redcuce the painless the final jump is.

    I HIGHLY recommend you read around this forum to better educate yourself. There's so many success stories to be found and so many stories than will help you better understand how passionate we are about helping others whether it be getting clean from subs or any other opiate. The people are quite amazing!

    There's soooo much more I want to say, but will end now. My only question is how long has it been since your very last dose of sub, and what was that dose?

    Stay Strong,

    Randy
    Catrina and Ming23 like this.

  3. #3
    Gurgi89 is offline New Member
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    It didn't take me months to become stable, just to get used to the different receptor activity of the sub as opposed to the methadone. It is a very different feeling drug. I have a history of chronic pain and found the switch difficult as methadone was a stronger analgesic for me.

    Last dose of sub was about a month ago, it was .1mg.

    I have already read the sub therapy plan, and have also already read through the forum. I just posted this because I think that the more information available the better.

    Your post is quite strange.

  4. #4
    Ming23 is offline Platinum Member
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    Gurgi
    Lol. Thanx for your post and sharing of experience. I believe you have good intentions. It has been our experience that at the higher doses, at beginning of taper, one can make much larger decreases. You suggest going from 32mg to 30mg. We suggest dropping to 16 perhaps.
    Larger reductions are possible at start, smaller reductions at end.
    I found nothing strange about Randy's post if u view it as a very knowledgeable person taking time to share advice.
    Best of luck to you! Good job getting clean!
    Randy35 and DawnMarie81 like this.

  5. #5
    Randy35 is offline Platinum Member
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    Quote Originally Posted by Gurgi89 View Post
    It didn't take me months to become stable, just to get used to the different receptor activity of the sub as opposed to the methadone. It is a very different feeling drug. I have a history of chronic pain and found the switch difficult as methadone was a stronger analgesic for me.

    Last dose of sub was about a month ago, it was .1mg.

    I have already read the sub therapy plan, and have also already read through the forum. I just posted this because I think that the more information available the better.

    Your post is quite strange.

    Gurgi,

    When you said in your original post, and I quote, "It took me a few months to get used to the suboxone, I believe due to its partial agonist activity as opposed to the full agonist activity of the methadone", I took that as meaning you just couldn't get stable on the induction. My bad for misunderstanding.

    As Ming mentioned, we find that most everyone that has the misfortune to be placed on massive doses of sub like 16 - 32mgs can indeed reduce those doses by very large reductions in the beginning. A person on 32mgs can safely reduce to 16mg, then 4 days later redeuce to 8 - 12mg and be just fine. The long half life makes that possible. You can reduce rather quickly down to around 4 - 6mg from extremely high amounts. Once down to the lower doses such as 4mg and below it's usually best to slow things down a bit. Of course theres always the exception.


    Anyway, glad you're off the sub and hope you're doing well. Stick around, we need all the success stories we can get!

    Randy
    DawnMarie81, Ming23 and AArkansas like this.

  6. #6
    AArkansas is offline New Member
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    I'm a newbie to the forum, but a loooong-time suboxone user. In fact, I was my doctor's FIRST sub patient! In all I've been told, and read through the YEARS regarding suboxone, any dosage beyond 16mg is overkill -- in that you reach a point of diminishing returns. The way it was explained to me was the fact that the buprenorphine binds to the receptors in the brain. Once 'bound,' any more mg's administered has no appreciable effect.

    Not saying it is 100% true -- just what I've come to know. I've been on 6mg strips for many years, and hope I can be strong enough to begin a taper soon.

    Keep up the great work on your tapering.

    Jimmy

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