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Curious about suboxone and precipitated withdrawals
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Curious about suboxone and precipitated withdrawals

I find so many things on this site that I never knew about.  I'm learning new things all the time.  One thing I don't understand, really, and have some confusion about is suboxone.  From what I gather, it's for people who want to get off opiates and it blocks cravings.  And my understanding is you have to have no opiates in your system, or you go into what's called precipitated withdrawals, which are supposed to be really, really bad.

So I guess I'm wondering a couple of things.  One is, if you have to wait until your through opiate withdrawal, why go on the suboxone?  Is it just for the cravings later, after you've withdrawn?

The other thing I was wondering about is does it vary depending upon the opiate you use?  Does suboxone work differently with oxys, methadone, etc?  And does it work with things like Valium or Ativan or other pills?

And it only works with pills, right?  It's not a pill for coming off alcohol, is it?  And only opiates?  I read on here (and NEVER heard this from the medical community) that Cymbalta has bad withdrawals.  Suboxone wouldn't work for that, would it?

Thanks for any information.  To all of you who are battling addiction, God Bless.  You are all an inspiration.
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21 Comments Post a Comment
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Avatar_f_tn
Oh, one other thing (for now :)  Why are precipitated withdrawals worse than regular withdrawals?  Are the symptoms the same, just more severe or are there different symptoms?
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Avatar_f_tn
Hi mellie.  I've researched a lot on suboxone and was on suboxone maintenance for almost three years.  I will try to answer what I can from my knowledge.  

Suboxone is only prescribed to treat opiate addiction.  Suboxone is made up of buprenorphine and naloxone.  Buprenorphine is a very strong opiate; but its a partial agonist, which means chemically your body is getting the opiate to relieve the withdrawal but your not getting the same 'euphoric' or high feelings as you would a full agonist (heroine, percocet, etc).  The naloxone is in there to prevent people from dissolving and injecting suboxone.  

The reason suboxone works so well to alleviate any and all opiate withdrawal symptoms is simple:  because bupenephrine is an opiate.  Works the same way to relieve any opiate withdrawal syptoms (symptoms).. it doest really relieve the symptoms, what it does is take you out of withdrawal by feeding your brain an opiate.

Proper induction on suboxone should only be done with a doctor as well as a maintenacne program.  You do not have to wait until your withdrawals are over, but you MUST wait until you are at least in moderate withdrawal to begin taking suboxone.  Usually 18-24 hours after taking your last dose of your opiate of choice.  

Because of the length that methadone and oxycontin stay in your system (especially methadone) the time you must wait before suboxone induction is much longer.  

Standard opiates, vicodin, percocet, are in and out of your system pretty quickly.. after 18 hours its mostly out or enough out to where you start withdrawal.

The reason for this is because pound for pound bupeneprhine is much stronger than most opiates people use.  When you take it too soon after using your regular opiate of choice, the bupe immediately knocks your drug of choice off your opiate receptors and binds to them tightly, thereby throwing you into precipated withdrawal.  Remember its a partial agonist.  So if you took it too soon every withdrawal symptom that builds during a cold turkey detox hits you at maximum strength all at the same time.  Its a shock to the system sort of and once that happens there is nothing you can do but wait it out.

The greatest thing I can say about suboxone having used it and come off of it is that it truly truly does relieve cravings.  Its so strong and has such a long half life that one dose a day does the trick (for most) and unlike when your using your drug of choice, your not waiting around until your next dose.  Your opiate receptors are saturated and full.

Its a very useful tool in recovery but it can also be a dangerous one.  Many people begin treatment not knowing suboxone itself is an opaite and withdrawal from subxone if not done exactly right (and even sometimes if you do do it right) can be worse than your itnitial drug of choice.

Hope this helped.
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736475_tn?1281262927
i was on methadone and had to wait 4 days after my last dose. alot of people go on it for the wrong reasons and end up abusing it. personally i don't get that. for once i found a drug that i don't abuse. psychiatrists are prescribing it which i also don't get. can they follow you up physically? idk. i had exhausted every possibility aside from going into detox/rehab and still had to think long and hard before making the decision. for me i think it's the right one. not forever, but for a while. i am re-entering society now in a functioning capacity.  i also hope this helped.
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199177_tn?1332183097
Most of these questions answers really diffrer from person to person and depending on what drugs you are on .These are why they are quiestion your should ask your PM doctor.For the most part sub is used for opeate wd but there are some PM doctors that do use it for PM .I am Kind of ceruos as to why you want to know are you considering trying it for pain,I would post on the PM forum and ask what they think about if for pm.


let us know what they say
avis
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Avatar_f_tn
i have heard so many different stories from people regarding suboxone. i used suboxone on and off for a few years...basically whenever i couldn't get any pills. just to avoid withdrawals. my boyfriend at the time had a prescription for it and we would take it when needed. i never experienced any precipitated withdrawals then. however, i started using heroin when pills became hard to find and eventually realized that my life was spiraling out of control. so, i decided to use the suboxone to quit opiates for good, rather than just avoid withdrawals. my doctor recommended that i stay in the clinic when i started on the subs but i couldnt take the time off of work so i decided to do it myself. i waited for about 10 hours, took two 8mg subs and went into horrible withdrawals. i ended up smoking a ridiculous amount of h the next day because i thought it would help. it didnt though...my doc said that i took way too much suboxone and didnt wait long enough before i took it. i tried again...this time i waited about 16-17 hours. to the point where i couldn't stand the withdrawals any longer...i still think i should've waited longer. even then i was pretty uncomfortable for a few days. that's my own personal experience though. i know people who have started suboxone and felt great! everyone is different.
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1331083_tn?1285915954
I take sub for a hydro addiction,it is great as long as u don't abuse and i have so all i did the first couple of mo was throw $500 abt down the drain im trying really hard to take it the way im suppose to and as long as i do it work's great!my docsaid the first visit thati only had to have the hydro out of my system so that took like a day and a half,it is not suppose to work for xanax is what doc said and isn't suppose to work for alchol so that is all i know besides im not sitting here high as hell on hydro's thank's to sub.Kitty
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Avatar_m_tn
I am down to about 3-4 40mg oxys a day (snorting) i was 10-12, but got down to 3 or 4, i have borrowed a su pill, the person who gave it to me said they broke it into quarters and it worked, can someone tell me please if this is true, will takinga quarter work, also how longshould i wait before taking one? any help would be great, ty
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683878_tn?1301550868
Absolutely, there's a saying with suboxone users that less is better. By taking too much, more than your reccommend dose, your pretty much wasting your suboxone. They come with pamphlets to properly show you how to dose yourself.

You must let it dissolve under you tongue and do not swallow your saliva for atleast 10 minutes while it's dissolving or you won't get the full benefits. 4 mgs should last you 24 hours just fine. I take 8 a day, and think I'm taking too much.
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Avatar_m_tn
Morning, i broke down this morning, mornings are my worst i feel like an *** that i couldn;t do it, i am so worried about this prec withdrawl (withdrawal) i have read about, and yes i have read site after site after site, i just don't know how long should i wait before doing it, i hate the withdrawls but to have them come all at once would kill me, if they do how long do they last is it like regular withdrawls, 4-5 days, i have read so many conflicting things, I am happy to know that taking a quarter of one will work, gives me hope, I am prescribed 10 40's a day for pain, but i lived witht he pain before, i hate i have to wake in the morning and do one, that is what gets me, back to topic, if the prec withdrawls do happen what can i do to stop them? I got my Suboxin off the street pretty much, a friend gave me mine and he got it from a friend of his, so there is no pamphlets, it takes a month or more to get into a clinic around here, so that i thought was easier, I appreciate you taking the time to answer my question, i know it seems stupid what i ask, i have been on them since 1996, one of the first in my area, they raised me up over the years, at one point i was taking 12 80's a day, ove rthe last few years i got back to the 40's, but i started to sniff them cause it took to long to take effect (10 months now) and as i said i got down to 3-4 a day somedays 5-6 but i try, i cant get lower with out feeling like **** for some reason, so anyways back to the questions..... how long do i have to wait till i start Suboxin, and 2. if the precep w/d's start how long do they last and is there anything i can do to stop them, will 4 days clean my system of the oxy's?
Again Thank-you to all that answer
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569676_tn?1315644758
I can totally understand your fear of precipitated wd's, been there done that, but not because of sub.

There is no real "Right" answer as to how long after your last dose should you take sub, as we are all different and metabolized drugs differently.  When I made the transition from Methadone to sub, I only waited 24hrs, and had a nice smooth induction, and got instant relief within 20 minutes of my first sub dose.

Check out this document, it opens as a word doc, but can be viewed as an html as well.  This is the Clinical Opiate Withdrawal Scale (COWS)  ITs the form the majority of clinics use to guage withdrawal levels before Buprenorphine induction.  You should be scoring in the Moderate range before taking Suboxone, best advice is to hang in there until you reach a moderate wd number, and then wait a little longer just to be sure if you can tolerate it.

www.csam-asam.org/pdf/misc/COWS_induction_flow_sheet.doc

Hope this helps, and good luck!

Henry
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Avatar_m_tn
I appreciate this, i will use it, my body seems to chew it up quick at night, if i snort a 40 at 11pm, at 3 am i am up sweating and restless, not heaving but not comfortable, by 6:30, i have some gags, sweats, and could rip someones face off, legs and shoulders ache to the point it bothers me, I was thinking of using alchol durring the day to try to get through the hours i need to do before i start sub, will it interfere with sub? I have done wd before but not by choice, only could do 15 hours before i cracked and went and purchased a few... I really want to do this, i'm just scared honestly, well on sub, can i still get **** done around the house or farm? or are you laid up on the couch???

To anyone else who can answer the questions about prec wd's i would really appreciate it... I understand it will be hell, but how long will it last and can anything be done to make it go away quick???? It makes me mad i could quit speed, coke, alchol all by sleeping but with no oxy's i can't sleep and am having a hard time quiting worst thing i ever did and it was prescribed....it's crazy, i realize i haven't been at it long but it feels like a life time
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Avatar_m_tn
I am sorry to post again but i am still looking for answers to a questions, To anyone else who can answer the questions about prec wd's i would really appreciate it... I understand it will be hell, but how long will it last and can anything be done to make it go away quick???? It makes me mad i could quit speed, coke, alchol all by sleeping but with oxy's i can't sleep and am having a hard time quiting worst thing i ever did and it was prescribed....it's crazy, i realize i haven't been at it long but it feels like a life time and does alchol have any effect on subs, i was thinking of drinking during the day to help with the symptoms and hopefully pass out, wake up and start the sub's, on the subs can i still work around the farm, do everday things i do with oxy's? I realize i have posted alot but i am serious about quiting, and am just scared, how long do i need to do subs for to have all the oxy exit the body, i don't want to just swap one for another, and be on them forever, i was hopeing like 4-5 days of subs, can i just stop subs or do i have to ween off, i will be taking 2 mg a day...I appreciate everyones help with this, my wife and son are behind me on this they just want answers also so they know what to expect and what can be done incase,
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569676_tn?1315644758
No problem!

Our brains break down opiates into their inactive metabolites at night while we sleep, its part of our nightly "repair" cycle.  This could be an explanation as to why you feel such severe wd's in the morning, that combined with the short half life of your DOC.

If you induct yourself on the sub correctly, you should feel ok.  This experience is different for everyone and a very personal one at that! Some it takes a few days of ajusting, and some like myself felt like a million bucks!  One side effect that some have during their sub induction is lethargy, but that goes away with dosage titration, adjust your dose accordingly!

I would advise against the alcohol route during this time...

Your brain is going to be a chemical storm during this time.  Your levels of Epinepherine, Dopamine, Serotonin, Acetylcholine, Adenosine, and all those other feel good and regulatory chemicals are going to be all out of whack... Hence why you not only feel like crap physically but emotionally as well.

Alcohol acts as a central nervous system depressant.  It interacts with some of the neurotransmitters listed above and interferes with communication between them, a problem we already have due to our opiate abuse.  Also, Alchol enhances the effects of GABA (Another Neurotransmitter) making a person sluggish to further things, alcohol weakens Glutamine making this sluggishness even worse. Glutamine is an excitatory neurotransmitter.  

Not to mention, alcohol use during buprenorphine treatment is contraindicated. I had to sign an alcohol contract when I was in sub treatment that I was aware of the risks of combining alcohol and sub. Of course there were times during treatment that I had a glass of wine or two with dinner, but nothing enough to knock me out.

Precipitated withdrawals are severe and acute, usually lasting less than a period of 24hrs or less.  If precipitated withdrawals are induced due to buprenorphine, once they start, it is VERY difficult to do anything to stop them due to Buprenorphines strong binding affinity to the MU (Opiate) receptors.

I hope this answers some of your questions.  I was never really any good at putting things into "Laymans" terms, so if you need anything clarified, feel free to speak up!

Good luck!

Henry
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Avatar_m_tn
So in basic terms you recommend against drinking prior to starting subs? also which would be better for me then, i took my last oxy at around 10am this morning, should i wait the day out and take it around 1-2 am or later if possible, or do my last one at 10pm, and then do it in the morning around 8-9 am because of the repair thing? My mornings have always been the worst, always. I have started 10 months ago snorting them because of the quick absortion so i could start work on the farm quicker, instead of waiting for them to kick in, I know i may seem stupid just looking for the best time to start them, i will answer any questions you may have so you could make the best recomendation, and how long should i wait approx before starting them, what symptoms should i look for before taking them, i got a   Clinical Opiate Withdrawal Scale from someone, and i understand that but when u feel like **** you feel like **** right, my heart rate can go up because i am stressing over it, so i am not sure about it, I appreciate your help trully, i will be glad when i am oxy free, the other question, how many days do i need to take subs for the oxy to leave the body all together, can i do 2mg a day for lets say 5 days, and then just stop, or do i need to ween off the subs from 2mg also, i can not do more than 2 mg for the first three days as my friend can't get more till Sunday then there is only 5 available then, broken into quarters will give me 24 2mg approx tablet, right now i have 4....i cant go to clinic because of the wait time, and i talked to my doc and all he did was raise my dose 1 more pill cause he thinks i am just withdrawn through the night, so he prescribed an extra 40mg tab to take at 2-3 am...i don't think he wants me off, he prescibed 10 a day, i take maybe 3-4, today has been 2 tabs. any and all help is appreciated, thank-you so much henry much respect
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Avatar_m_tn
Sorry, i forgot to ask can i take over the counter stuff like sleep eze to help sleep and gravel for the stomach and tylenol with codein (tylenol 1's) to help get through the beginning of wd's just to put more time in?
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569676_tn?1315644758
I cant legally give you any kind of dosing information or schedule, but if you look around on the net hard enough for it you can find it.  As far as the wd's I personally if I were doing this on my own would wait until I absolutelly cant stand it anymore, and then wait a bit more after that, just to avoid those potential precipitated wd's

OTC meds may help, I have read some users used Benadryl (Same thing in sleep eze) to help with the sleeplessness, however there are also reports out there that antihistamines (Like benadryl) can aggravate the Restless legs syndrome that comes with withdrawal and anxiety.

Try some melatonin combined with valerian.  When you take the melatonin, make sure the room is dark is that is the only time our brains produce it and activate it.

Watch yourself with the gravol, It in itself can actually be addicting and come with its own set of withdrawals.

Tylenol #1 is just another opiate, that is in the long run only going to prolong your withdrawal.

I have to say Im genuinely concerned here, I know you want to get off the opiates, but you have asked about using two other opiates to combat withdrawals. Along with alcohol.  Suboxone to get off the oxy, Tylenol #1 to get off the suboxone, Gravol to get off... you see where I am going.

What you are doing is self medicating, and I strongly urge caution doing this, especially with some of the substances you have mentioned using above.

The harsh reality, is that you are going to have to feel some pain of wd no matter what.  There is no easy out with this one bud.  I wish I had better news for you.  I understand that getting in to see a sub doc is tricky business, but can you get in with a general practice doctor to help you out?

I hope I dont come off as sounding brash, I just want to see you succeed in this endeeauvor and never have to do it again.

Henry
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Avatar_m_tn
Hello again
  I am sorry i didn't realize gravol was addictive, and as for the tylenol i a didn't realize it was an opiod, i just thought to help with some of the muscle aches and pains and spasms, and sleep eez just to sleep, i will not take gravol or tylenol then i didn't realize they were like that i understand i am going to have to go through some pain was just listening to ppl here and asking if what they were saying made sense, I am feeling rough now but not sick so at least it is starting, i will wait till i am ready to kill someone, then walk that way and just before i do kill whoever than i will take the sub...lol....i appreciate your help, you were not brash just honest i would prefer that that ***** foot around and me misunderstand what is being said, thank-you, as i said just looking for something to help with the aches and pains, also where or what contains melatonin,or valerian, i havent heard of either,, ty
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Avatar_m_tn
Well i waited 15.5 hours couldn't do it any more, i did 2mg of Sub waited an hour didn't feel alot better but alittle, waited an hour or so did another 2mg just a few mins ago, hopeing it will get rid of the leg pains left over from the w/d's....but atleast i have started right? lets hope all goes well and i can quit the oxy's altogether.
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569676_tn?1315644758
Thats excellent!

Glad to hear you are doing ok.  Typically if you were to experience precip wd's they would come on relatively quickly due to taking the sub sublingual.

You placed it under your tongue and let it melt right???

Now that you have taken 4mgs, give yourself a little time.  Suboxone typically peaks within a few hours, so it may take some time to begin to feel the full effects of your does.

Good luck, and keep us posted!

Henry
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Avatar_m_tn
Ty, i must say it has been 3.5 hours i do feel better, however my legs still hurt likei am wd..i have tried hot bath, tylenol, even a heating pad, any suggestions? I had no prec wd, i was scared of that, so i pushed on well wd as long as i could. I have a question or two, how long will the leg aches last? should i expect anything else? And now that i am taking Sub, and oxy won't have any effect now will it, what happens if i get hurt and end up at the hospital? is there a medication they can give me for pain? I appreciate your support and help, ty everyone
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569676_tn?1315644758
Try eating some bananas or drinking apple juice.  They are loaded with Potassium which can help with the leg cramps.  Any kind of electrolytes will help as well, gatorade is good, keep your fluids up to help with the cramping also.  This will subside over time.

Yes you are correct.  Oxy wont work or will have a greatly diminished effect while on bupe (Sub) If you are injured and require opiate treatment, you will not be left to deal with the pain.  There are treatment protocols out there that Doctors have access to in order to treat the unique nature of this medications action!  Dont worry about that.

HS
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