suboxone withdrawal, a more positive note

thank you. this has been the most informed and truthful info on sub w/d i've seen so far. There are meds to deal with the mental cravings. For me Gabapentin has been AMAZING. I still feel the tingling skin, bathroom issues but it is in no way compared to the w/d i went thru coming off of heroin. Get to a NA meeting, get a sponsor, life does get better.

First off, I don’t know where you are getting your information on Suboxone® or other opiate withdrawal, but Ellsee’s account of what it is like to withdrawal from Suboxone® is subjective and not quite as informed as you may think.  Ellsee is basing her account on the assumption that everyone using Suboxone® has wrecked their bodies with opiates for years which is not always the case.  She also mentions a relapse of 60mg of oxycodone while on Suboxone® with a 4 day withdrawal from hell.  Although I don’t know the specifics of this incident, it doesn’t quite add up, and the experience she describes may be what is called precipitated withdrawal brought on by the Suboxone® mixed with the oxycodone, but I’ll get to that later.  Also, I’d like to point out that gabapentin is not a psychoactive drug that can treat cravings, but a drug that treats nerve pain associated with Fibromyalgia and Restless Leg Syndrome off-label which can help with the temporary restlessness similar to RLS associated with opiate withdrawal.

One reason Ellsee’s account is somewhat misinformed is because comparing other opiate withdrawal such as oxycodone to Suboxone® is like comparing apples to oranges.  Buprenorphine, the opiate agonist in Suboxone®, is different from other opiates due to its chemical makeup and two distinct properties.  The first difference is that buprenorphine is a partial opiate agonist whereas other opiates are full agonists.  This means that the buprenorphine partially fills the opiate receptors in the brain tricking the brain into thinking the receptors are being fully occupied when it is not.  Because of this, buprenorphine does not have the same euphoric effect a full opiate agonist carries.  Secondly, buprenorphine has a stronger affinity to the opiate receptors in the brain than other opiates.  This means that when buprenorphine is actively occupying opiate receptors in the brain, any other opiate taken, whether it’s IM, IV, or by mouth, will not be absorbed into the receptors because the buprenorphine occupied receptors will not allow the new opiate to kick out the buprenorphine because the bond between the receptor and buprenorphine is too strong.  These combinations along with its extremely long half-life with a mean of 36 hours make buprenorphine a good stable medication for opiate dependence; however, there are downfalls as they say: you have to pay the piper at some point.

Now that some real scientific information about the drug has been established let me clarify some things in Ellsee’s post.  She mentioned the following:

“When you relapse on any type of opiet while using Suboxone, the withdrawal you will feel is from the drug, not Suboxone, and trust   me it is worse then any other withdrawal out there. After going through 4 days of that with no sign of relief, i went back to Suboxone at 4mgs a day for 3 and a half weeks.”

First of all due to the partial opiate agonist property and the long half-life of Suboxone®, this shouldn’t occur.  A relapse on Suboxone® shouldn’t be felt as the opiate will pass through the body without ever bonding to an opiate receptor unless one detoxes from Suboxone® for about 3 days before taking another opiate.  Also, the withdrawal she experienced could be due to precipitated withdrawal, but without more details this is just a hypothesis.  But, in case this is what occurred this is how it would happen: since, like I said before, Suboxone® has a higher affinity for opiate receptors than any other opiate if Suboxone® is taken while another opiate such as oxycodone is actively occupying the opiate receptors, the Suboxone® will violently kick the opiate out of the receptors sending the brain into rapid precipitated withdrawal syndrome that cannot be stopped.  It must run its course which can last up to 5 days, and it is an excruciating withdrawal unlike any other. 

Another excerpt I’d like to comment on:

“…a friend of mine has been on Suboxones for 2 years, and occasionally runs out before he has the money to renew his script He goes a week or more sometimes without Suboxone, and suffers from no more then a headache and occasional diarreah and hot flashes. Many people confuse the psychological aspect of this particular withdrawal with the physical. If you are capable of realizing which is which, this withdrawal will not be as difficult as many have let on. People suffering from yeares of addiction coming off of Suboxone are still mentally recovering from their past struggles, are will probably continue to develop issues as time  goes on. Drug recovery is a long and difficult process, withdrawal is not.”

Depending on the dose being taken a person can go for some time without going into withdrawal due to Suboxone’s long half-life.  Also, the issue surrounding Suboxone® withdrawal is NOT the ability to identify the difference between physiological and psychological aspects of withdrawal.  The issue arises when people are misled to believe they will not experience any withdrawal or when they have unreasonable expectations.

Also, the notion that Suboxone® withdrawal is always a breeze and that the horror stories found are absolutely false is not entirely accurate (now getting into the downside of Suboxone®).  These stories do carry weight, and they are not completely psychological in nature.   Some psychological aspects of Suboxone® withdrawal in some people are really physiological manifesting in a psychological way.  It is called PAWS or Post-Acute Withdrawal Syndrome.  This doesn’t occur to all people who withdrawal from opiates, but it does happen, and the longer a person is on opiates the higher-risk they are for developing the syndrome.  This is a long drawn out form of withdrawal that can last up to 2 to 3 months at the maximum.  It’s the brain’s way of repairing itself after years of opiate misuse.  It is characterized by fatigue, anxiety, and depression following physical withdrawal of opiates.  This doesn’t happen to everyone, but the people it does happen to seem to post about it more often than the people it doesn’t happen to as they want to warn people of the horrible effects of Suboxone® withdrawal assuming this is the norm; therefore posts seem to be skewed to the horror stories because people who breeze right through withdrawal aren’t inclined to tell their stories because it doesn’t have much shock value.

My final point is that everyone has different body chemistries and has used different types of opiates for varying lengths of time all factors of which come together in determining how long and how severe one’s withdrawal experience will be.  But everyone dependent on opiates share one thing in common which is the fact that at one point or another everyone has to go through withdrawal and pay the piper his dues.  Once ready and strong enough to do so, there is no point in dragging it out.  The simple fact is that no matter how much one tries to gather information on how long it will take or what to do to minimize the effects it still must be done, and it is not impossible.  My advice is STOP reading horror posts, gather the meds required such as, gabapentin, clonidine, some B vitamins, and possibly some benzodiazepines to combat anxiety and sleeplessness, and just do it.  Remember it won’t last forever, and it probably won’t be as bad as the horror stories out there.

Good Luck!