Originally started typing this to what I later saw was a 3 yr old post lol but I had gotten into it so I figured I'd share. He was being taper from 6-2mg over a course of 7-8 days! Just reminded me of the nonsense going on out there and was the impetus for this post. If it sounds know it all, I apologize. The more I learn the more I know I don't know nearly as much as I thought I did. It's just the paths described below work daily... I'm sure of them empirically, not bc I think I solved some riddle. And responsible drs universally agree, and even the bad ones pretend they do to fellow docs but then just keep people on the meds... Not all but there are many sadly doing this and it's a betrayl of their oath.
Here's my late answer lol
Respectfully, that is way too fast. Not saying it isn't being tapered that fast by respected docs, but it also doesn't mean it's right. You have to remember that most of the drs prescribing subutex/suboxone graduated medical school 10-20 years before the drug was in trials! And regardless, any drug of this nature requires refinement of treatment course. This is not being done effectively.
In my merely drilled into my head,seen it first hand a billion times, can sketch you the diagram of the interaction in your brain and explain it ( good luck with most old guard docs, you will get it turns some receptors on and some off... Comprehensive lol) opinion... Sorry for that butchering of modern English :) There are two routes for this drug. You WILL see it trend this way across the board over time I guarantee.
First you access a patient primary and secondary risk factors regarding addiction vs dependence. There is a big difference here. Dependence is usually under medical care, though many under medical care become addicts. This dependent is every bit as physically and almost as emotionally married to the opiate. The key difference is that they have less association of the drug with recreation, more often for pain contro, though the two always mix, always. But they also lack the seeking behavior and the ritualization, not to mention the peer groups developed by the addict. There are so many more points but I meant to describe treatment, sorry for the digression, it's my passion, it hits very close to home 4 times for me. In short, those falling in with mostly dependence traits should be treated QUICKLY.
There is no point to keeping someone of limited relapse potential on sub for any longer than stabilization and tapering. These patients see the best results, typically of course there are always exceptions. Even here nothing should be rushed! Achieve full stabilization (no symptoms) then begin a symptom based taper. In the higher ranges bigger jumps are possible but the rule is never be uncomfortable. You don't have to be! It just might take a few weeks longer. Fair trade. These patients really do see nearly painless tapers in most cases, utilizing the limited receptor saturation due to the short duration at peak dosage and the slow taper. It is ABSURD for any limited relapse risk to be on an extended stabilization period. Pointless... And by describing the second method you will gather why this is such a no no.
just a a note, typed this late, with no spell checking or grammar. Might have misspoke but the point is there and it's the truth... Or it will be when it becomes as profitable.
The majority of patients will be true addicts, not bad people, sick people. In this case, you still aim for the lowest total mg for stabilization, but it should be enough to avoid any suffering past the necessary withdrawal waiting period. Which by the way... For most short acting street opiates is 12-18 hrs... Not the 3 days some places make people wait. That's 5 half life's... Seriously? Just check the pupils.
Once stabilized an addicts immediate plan should be to adjust to the new life and bring their affairs in order. After this settling in period, the dr with comprehensive history from the patient regard psych/drug/criminal history should formulate a specific plan for duration of use and whether a taper should ever even occurs. Some are better off on sub for life if they are doing well. The factors are many for duration prior to taper, but it's mainly length and severity of use. You still want them on only so long as to get them ready for sobriety. This is tweaked as they respond to treatment.
The taper should be slow enough to avoid symptoms. .5mg per month when you get near the end is fine. Never jump off til 1 or preferably .5mg. Dr s need to tell people the bad symptoms that can occur, many do not share this info, or describe best case scenarios. It can be difficult lt No matter what you do, but not undo able. While perfect, it IS a wonder drug that stabilizes lives, saves families, and gives people a fighting chance. It just needs to be prescribed and patients treated uniformly per their situation with the goal of better health, not more patients for weekly or monthly paydays as is the current state of things. But the drug is not bad. It is a quantum leap in treatment options especially for extreme addicts which are more and more the norm. Way better then methadone which is an absolute horror to withdrawal from. If all these sub horror stories were regarding methadone I'd believe it, god bless you if you kicked that.
My whole point is those are the two ways your dr should be dealing with things. You probably know which catatgory you are in, so if the treatment isnt right ask why? Advocate or you will get burned in life, ESP with drs. Find the right one... It can make such a difference. I see it daily.
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Thank you for your post. I just started Tues on 8mg twice a day, detoxing from vicodin. It is Sat morning and I am stable I think. Now I need advice on where to go from here and taper so to avoid any bad symptoms from the Subs. I need to try to avoid bad symptoms of the with drawl of the Subs, even though I have only been on them for 5 days. I am on the films not pills. HELP and THANK YOU
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Wow... Sorry for the huge paragraph! I had a ton of spaces that made the paragraphs easier to focus on but I think the posting takes them out.
Lynn, 1st time I looked back here since last night... You posted 2 mins before I looked. You have good luck on your side it seems :)
In answering you directly I can probably be alot more concise and clear for every one, wish it would let me use paragraphs! Now remember, this is general, I have not examined or spoke with you so this is just knowledgabe advice, it's not a trip to the dr. Film/pills are same deals still same drug. The real question you need to answer for me to give you my opinion is are you ready to be clean? We all want to be but can you maintain sobriety? This means no users around you, no thoughts of using at familiar times or for events etc.... I think even if I was a low relapse risk, if I needed a sub detox it would indicate enough factors to at least make me stop and think, am I ready? I don't think you have had enough time feeling decent to think that through. Dont be hasty in a critical decision. You stabilized, great, stay there a week and then try a .5-1mg drop. If you feel bad it's too soon. Move back up. But my bet is You will probably be able to drop pretty easily down to something real low real quick. Unless your Vicodin use was unreal but it doesn't sound like it, you will probably be able to get to 2mg or less over the next 1-2 months with no I'll effects. Maybe less. Please use that time to think about whether you are ready in the myriad of parts of your life that need to be right to succeed in sobriety. An easier sub detox doesn't mean much if you relapse! When you do decide to stop, taper in .5mg increments and drop following each stabilization. May take a week one drop, 2 the next. At .5mg total, stop use. Prepare by having all the aids well detailed in other posts to control symptoms. I hear thi s question alot so I bet it is part of what you were asking which is basically "if I rush my taper on the suboxone can it not 'take hold' and I will avoid any withdrawal?" the short answer is we don't know. It works sometimes, other times it doesn't. Truth is most of the time EVERYONE pays the piper one way or another. Most cases, the extremly quick taper is essentially as bad and drawn out as the detox it is avoiding, and it might not avoid it still. 6-8weeks sees very similar detox outcomes but the taper is way less tough. And, as if its my mantra, NOBODY who just went through dependence/addiction and cessation is Of any right mind to make the Incredibly difficult decision of Whether they are ready to stay sober, be it due to cravings,recreation,friends,environment ,psych probs,pain management... Just to name a few. You should be very proud of this major step forward you have taken. You can do this, that part I promise you, it's not just advice. May all find peace.
Lynn, 1st time I looked back here since last night... You posted 2 mins before I looked. You have good luck on your side it seems :)
In answering you directly I can probably be alot more concise and clear for every one, wish it would let me use paragraphs! Now remember, this is general, I have not examined or spoke with you so this is just knowledgabe advice, it's not a trip to the dr. Film/pills are same deals still same drug. The real question you need to answer for me to give you my opinion is are you ready to be clean? We all want to be but can you maintain sobriety? This means no users around you, no thoughts of using at familiar times or for events etc.... I think even if I was a low relapse risk, if I needed a sub detox it would indicate enough factors to at least make me stop and think, am I ready? I don't think you have had enough time feeling decent to think that through. Dont be hasty in a critical decision. You stabilized, great, stay there a week and then try a .5-1mg drop. If you feel bad it's too soon. Move back up. But my bet is You will probably be able to drop pretty easily down to something real low real quick. Unless your Vicodin use was unreal but it doesn't sound like it, you will probably be able to get to 2mg or less over the next 1-2 months with no I'll effects. Maybe less. Please use that time to think about whether you are ready in the myriad of parts of your life that need to be right to succeed in sobriety. An easier sub detox doesn't mean much if you relapse! When you do decide to stop, taper in .5mg increments and drop following each stabilization. May take a week one drop, 2 the next. At .5mg total, stop use. Prepare by having all the aids well detailed in other posts to control symptoms. I hear thi s question alot so I bet it is part of what you were asking which is basically "if I rush my taper on the suboxone can it not 'take hold' and I will avoid any withdrawal?" the short answer is we don't know. It works sometimes, other times it doesn't. Truth is most of the time EVERYONE pays the piper one way or another. Most cases, the extremly quick taper is essentially as bad and drawn out as the detox it is avoiding, and it might not avoid it still. 6-8weeks sees very similar detox outcomes but the taper is way less tough. And, as if its my mantra, NOBODY who just went through dependence/addiction and cessation is Of any right mind to make the Incredibly difficult decision of Whether they are ready to stay sober, be it due to cravings,recreation,friends,environment ,psych probs,pain management... Just to name a few. You should be very proud of this major step forward you have taken. You can do this, that part I promise you, it's not just advice. May all find peace.
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