The Opioid Antagonist

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.

12 thoughts on “The Opioid Antagonist

  1. Hello Kx… I’m glad to hear that you are on the path to be free. Please know that you have a wonderful and caring circle of friends and family that always seem to be prepared to help you along the way, unconditionally…. including me. I am actually a wealth of information regarding the subject of detoxifying the body, as well as the spirit. I have done much research over the past few years, and have encountered many people with the same troubles. Addiction is hard… hard on the mind, hard on the body, and even harder to put into words. Its an ailment that eats away at yr inner soul. I was finally diagnosed with Fibromyalgia last year after years of agony. A lot of the rules for complete health apply to the rules and restrictions of facing addition and withdrawal. Control and willpower are a constant struggle, and i empathize with you in this matter. If you would like to know the things to eat and do to make you more comfortable…to put yr mind and body more at ease, please don’t hesitate to contact me. I have been thinking about you lately and I miss you a lot. Send my love to the fam, and just know that i am here for you as well. :) Good luck my love. xoxo….Sabrina

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    • Thank you, dear. I am happy to hear from you and I’m glad you’re doing so well! The treatment center I went to was hollistic so they were big on eating healthy, taking vitamins like gaba, melatonin, fish oil, neuro-replete (adrenal lift) and amino acids, etc. The doctor would give me handfuls of vitamins, many of which I could hardly swallow. But they helped, particularly the adrenal lift. I feel better now than I did- my body is beginning to repair and restore the natural chemicals I depleted after years of suboxone and opiate abuse. But any suggestions you have are always welcome and I miss you very much. Please send my love to the wifey and know that you are in my thoughts and prayers. Robbie is in town today! It’s like old times. Wish you were here.

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  2. Pingback: Making Sense of Subutex | The Wellness Quest

  3. Very engaging article. I was a counselor at an opiate treatment program and many patients had a very hard time coming off suboxone and subutex. I try to spread the word how important supplements and nutrition are for getting off these medications. The main reason people feel so bad is because opiates mimic endorphins, the potent natural pain-killing neurotransmitters.
    After taking opiates or even partial-opioid agonists for the brain stops producing endorphins due to the these artificial endorphins short-circuiting brain chemistry. Even after tapering diligently the next few months can be so hard that most people relapse due to feeling so bad and not being able to take it anymore.
    My best solution to combat this post-acute withdrawal is to naturally stimulate endorphin production. The supplement DL-Phenylaline (DLPA) should be taken along with a mulivitamin/mineral. In one study a single dose of DLPA increased endorphins by 300% and 6 days later the levels were still the same. Also a protein rich diet consisting of at least 20-30 grams 3 times a day helps dramatically improve brain functioning.

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    • Thank you for all of the great advice. I will def be looking into the DLPA. Do you have any suggestions about replenishing the adrenal glands? In treatment, my test showed that my adrenal glands were extremely depleted. They said that the depleted glands were to blame for the long term fatigue and fierce anxiety. Not long ago, someone recommended I try kratom for the fatigue and anxiety. I started to take it and felt immediate relieved. It triggered that addictive part of my brain so fast that before I knew it I was dependent. I’m not saying kratom isn’t a wonderful remedy for some people, because I don’t know much about it. But, the withdrawals were almost as bad as the withdrawal from OxyContin and Suboxone. I’m fairly convinced that my body craves anything to fill those opioid receptors. Any thoughts on that? I’ve since stopped the Kratom entirely, and it’s been a long hard road. But, by God, has it been worth it. My brain functions in ways I could have never dreamed of before. I just want to take care of myself and do the next right thing but it seems I’m always trying to fill a void…not just the emotional one either…the one in my brain. It feels like something is missing. Based on your comment, could it be endorphins? Not just because I took those medications for so long, but also, is it possible that I was born with a deficiency? Thanks for your feedback and advice. It’s so helpful when people like you take the time to offer your professional opinion:)

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  4. Yes kratom can work well to get off but like you said, it doesn’t fix the underlying problem. While mainstream treatment relies on counseling, addiction education, relapse prevention, cognitive behavioral therapy and relapse prevention, it fails to address the physical aspect of addiction. Any treatment that doesn’t include correction of the imbalances in biochemistry can only mediocre results at best.
    Unfortunately the majority of addiction professionals still think substance abuse is the result of low will-power, personality defects etc. They think counseling and and other approaches can help fix us. In the meantime, we are receiving all this therapy but things still don’t feel right. We crave these drugs despite counseling and education. Brain chemisty imbalances occur due to the following: emotional and physical stress, genetic predispositions, toxins and substance abuse. Doctors often treat the symptoms of these imbalances with medications, which only mask the problem temporarily and actually make it much worse in the long run! As far as your taxed adrenal system goes my guess is you’ve been overloaded with stress. The constant fight or flight raises cortisol and is one of the most common ailments in America. Also, the use of stimulants like coffee and soda also significantly contribute to adrenal fatigue. Fortunately there are things called “adaptogens” that help restore the body to baselines functioning by promoting the facilitation of homeostasis. Gingeng and ashwaganda are two of the more popular adaptogens. By taking one or both of these for a few weeks you can reset your adrenal system and increase natural energy. There is nothing better than adaptogens to help your body respond to physical and mental stress. I’ve found that most addicts choose a particular substance due to them being deficient in the neurotransmitter the drug mimics. Opiates mimic endorphins, alcohol and benzos mimic GABA, meth mimics the catecholamines……..it goes on and on. I recommend absolutely everyone I meet with a current or even past substance abuse history to read “End Your Addiction Now” by Dr. Charles Gant, and “The Mood Cure” by Julia Ross. Both of these books have everything you need to know about correcting imbalances naturally using supplements. They both have amazing neurotransmiiter quiz’s, and after you take them it tells you which ones you are probably deficient in, then there is a list of supplements to take! Dr. Gant’s Power Recovery Program using this method produced an 86% recovery rate after two years on a study of almost 300 people. These numbers are unheard of in addiction treatment.

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  5. I was on subs for a month to keep me clean while waiting to get into a treatment center. I have to agree. I was detoxed from them within a week, and had 4 days thinking I was home free- no such luck. I experienced acute detox all over again but this time it lasted over two weeks. Severe GI issues, profuse sweating, insomnia, and horrible anxiety. It was honestly worse than detox from the opiate pain meds I had abused. I hate Subutex and Suboxone.

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