I have been home for ten days; the first seven days were exciting, albeit overwhelming, and I woke up every morning feeling grateful to be alive. However, the past three days are becoming increasingly difficult and I’m almost obsessed with learning as much as I can about long-term subutex use and detoxification. It seems that I’m experiencing post-acute withdrawals; I feel exhausted- plagued by negativity and sadness. It’s tricky because a major part of post acute withdrawal is psychological and although I am all too familiar with the horrors of opiate detox, these post withdrawal symptoms feel all too real. I am finding that I need to be open about these feelings if I am to push through this. At this point, I’ve been free of subutex for over two months and free of all narcotics for forty days. Since I was prescribed subutex for the past five years, it could take up to five months for the P.A.W.’s to totally subside. The physical ramifications of this process are difficult to withstand but what’s worse is that I’m experiencing cravings for the first time in years. Buprenorphine is a partial opioid antagonist with a very high binding affinity for the μ opioid receptor in the brain. Although buprenorphine binds to the receptors, it does so without a perfect fit. As a result the Buprenorphine tends to occupy the receptors without as much of the opioid (euphoric) effect. The receptor is tricked into thinking it has been satisfied with opioids. This in turn prevents that receptor from joining with true opioids. Suboxone (Buprenorphine/ Naloxone) tends to stay with the receptors, blocking them, much longer then opioids do. This stickiness, is what makes Buprenorphine last so long, up to 3 days. The long half life is also what makes the detox so difficult. Last week I went to see a psychiatrist for a follow-up visit and by the grace of God, I had to push the appointment time back by a few hours. Had I kept my original time slot at 11:45 am I would have gone alone but because I rescheduled for 4:45 pm, my cousin, Sam, came with me. She was a blessing because I was not prepared for what this doctor was about to tell me. I felt uncomfortable the moment I met him and I could tell right away that Sam didn’t like him either. After introducing myself I said, “how are you today?” and his reply was, “depressed.” Weird for a doctor. But that’s nothing compared to what he said once we were face to face in his office. I explained my situation and told him which prescriptions I was prescribed in treatment. Once we discussed my situation, family history and all that fun stuff, he started with his professional opinion. I’m just going to preface what he said to the best of my ability.
You should know, I am certified to prescribe suboxone and subutex for opiate abuse. In my opinion, you should have probably never come off the medication, in fact, if I had been prescribing it I would have doubled your dose to maintain your symptoms with more efficiency. It’s great if you can maintain sobriety but from what I have seen, opiate addicts are some of the more difficult to treat. The chance of relapse is very high for you (around 98 %) and from my experience, most addicts in your position end up dead from an overdose. This is a life or death matter and although it’s best to be free of all medication if possible, subutex is a better alternative to death. If I treat you, and you do relapse, I need you to be one hundred percent honest with me so we can consider putting you back on the subutex or perhaps even methadone.
My First Thought (Wrong): “No problem. WHEN I do relapse, I won’t have any qualms about being honest if it means this guy is going to reward me for it!” On Second Thought: I am smarter than my dog. I can withstand negative-positive reinforcement. Final Thought: Get me the hell out of this room before I word-vomit all over this man. My thoughts started racing and I immediately began scheming. Not only did this guy rattle my faith, hope, and courage, he literally gave me permission to use and abuse my drug of choice, forever. I nodded my head in agreement as he explained he was not an addiction specialist (why he has a certification to prescribe suboxone is beyond me) and that he doesn’t have much experience treating patients like me. He does, however, have a text-book filled with medical statistics (proof in numbers that the odds are not in my favor.) Once I conjured up enough courage to leave his office WITHOUT A PRESCRIPTION FOR SUBUTEX, I grabbed my cousin and we took off towards the nearest exit. I was lucky and relieved to have her there with me because my thoughts were a mess and I was literally battling this devil inside of me. Since that day, I have found my post acute withdrawals to be increasingly more difficult to manage. I’ve been doing some research about long-term subutex use and long-term withdrawal symptoms. There isn’t a lot of information out there, in fact, there is a lot of mis-information. I chose to go to treatment in Florida because most of the facilities in Maryland recommended I NOT come off the drug. Florida, being the U.S. recovery capitol, yielded treatment facilities with a much different perspective about subutex. I was reading random posts written by people who have endured similar hardships and I stumbled across one which is of particular interest to me. (Posted below.) It’s nice to know there are other people who understand what I am feeling and who can verify my sanity (or lack thereof.)
A brutally honest personal account of quitting sub after 7 and a half years
I was started on 32mg suboxone almost 8 yrs ago for ultram withdrawal..which makes me laugh now. I am a RN and took 4-5 ultram a day for 5 yrs and when I wanted to get off of it, my doc just got his liscence to prescribe the new cure all—-suboxone. He is a physician, addictionologist. He ASSURED me that this drug would help my pain (I have 2 plates in my neck and rhuematoid arthritis and systemic lupus erythematoisis) AND that I would not feel high, AND that there was little to zero wd syndrome. Well, that is the biggest bunch of crap I have been sold in my whole life. Lokk, I did Heroin, Demerol IV for years, I do have a significant history of opiate abuse. So when I was promised thar this was my new miracle drug, I was all in. About 4 yrs after being on 32 mg a day…I still cannot find any reason why I was dosed that high and never told to taper down, and I still dont know why my doc could have in any way thought that 32mg of suboxone a day for OVER SEVEN YEARS was a therapuetic dose. So here it is….I believe bupenorphrine, subutex, suboxone is great to help wds if used for under a month. I am on day 53 off subutex, after 7+yrs and it has been the most agonizing, hellish, unbelievably miserable experience of my entire life. for the first 3 weeks I could not even believe the severity of my withdrawals. I have detoxed cold turkey after injecting heroin for a yr straight and detoxing from sub made that look like a trip to disneyland. The 1st 3 weeks I truly thought I was going to die, even with clonidine, benadryl, immodium and flexeril. My heart was beating 130-160 beats per minute laying down, I could not catch my breath, could barely walk without pausing every few steps, could not even feed myself without concentrating on holding the fork. Long term bup use is the same for everyone. I have found hundreds of people that have gone through the exact same hell. But isnt it funny how all the prescribing info states it still has little to no wd syndrome? I am on day 53…I still have chills, soaked in sweat, lethargy, sneezing, insomnia, severe fatigue like i am wearing a lead suit…unlike any fatigue I have EVER felt withdrawing from opiates, even H and oxys. And it goes on forever. This has been worse than spine surgery, abdominal surgery and every other illness I have ever experienced, even if they were all at the same time. this has been a hell that I struggle to find the words to get my point across. This drug does NOT save lives if used longer than a month, maybe 2 max. It is ridiculous that it is still being prescribed as maintenance.