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low dose naltrexone for subutex paws

   ok a little history first, 10 years on herion and 6 years on subutex. Went from 12mg to 4mg to 0mg. Went in a 5 day detox (detox 5, uk). It was a little expensive, but for me it was worth doing because my sub use was starting to effect my work. wow looking back i do not know how i kept my job through a 10 year smack habit, My breakfast used to be a bag and a joint hehe. Any way, the detox itself was quite easy, i did not even vomit or have diarrea. So they must have there meds right now. (When i first went in a few years ago, it was a different story, i ran out of boxer shorts hehe). What they do not tell you at the end of the detox, is that the next 3 months can be hell for long term sub users.  Before i left i had a 3 month Naltrexone implant put in. Would i recommend a implant? well yes and no. No because i felt really depressed for the 3 months i was on it, but a lot of that could of been because of the detox. Naltrexone blocks your own natraul endorphines as well as all opiates. Yes, because it guarantees that you will get 3 months clean under your belt, even when you think you cannot take anymore.
     So its been 4 months now, still not 100% because of paws, if i look back its not half as bad as it was. The deep depression has gone, energy slowly coming back, sleep starting to get better. Not really want to wait another 4 months to get 100% better.
   So thought i would try low dose naltrexone at night 2mg, i tried it for 3 nights, well i was surprised, By day 2 i felt good again, not 100%, but 90%. (At low dose's, it blocks your endorphine receptors for a few hours, so when it wears off your brain is meant to compensate and produce extra endorphines eg 300%.). I had high levels of energy and my motivation had come back. As an experiment i stopped and 2 days later everything went back to normal eg energy and motivation a little low. So i can report it does work for the short term.
    Has anyone else experimented with ldn for paws, i would like to here how you got on long term? I stopped because as we all know, you do not get pleasure for free, there is always the day we have to pay it back 10 fold. I remember thinking subs were wonderfull at first, how wrong was i hehehe.
     So i was wondering if ldn gives you a endorphine hit through out the day, i guess your body would get used to this, so does paws come back after you stop taking it? does it make paws worse? How long does it work for? before our brains get used to the higher endorphines levels?
     Also how long there paws last for? meant to be going on holiday with my girlfriend soon, but not really want to go if i still have paws. Oh one last question, has anyone been drinking when in paws, does it make it worse? thanks
  P.S My friend did a sub detox but did it the taper method, i think this method is a lot better for paws, as it gives your body and brain time to adjust. He reports feeling fine now.  
      
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271792 tn?1334979657
Were you diagnosed by a doctor as having PAWS?
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Avatar universal
I have know experience about naltrexone, or  sub detox,  I can only tell you my story.
I went c/t off lortabs, in the last day of march of this year.  Now, I am having Paws, and there are days it is pretty bad. I am 46 days out and still not liking life right now.

About the drinking here is what happened to me.  One week ago, I was cooking supper.  Italian food we were having, so I decided to pour myself  a tiny bit of red wine.  I mean probably about less than half a cup.  I thought maybe it might relax me. WRONG!!!!!
It really made me feel, almost like I was going to have an anxiety attack.  So, my friend that is all the experience I can help you with.  Just stay the course, and be advised about not drinking caffine during w/ds and keep hydrating with water, thats what I use and sometimes gatoraide.   I have not experimented with anything, else to try to ease my w/ds , except. On the days I cant stand it, I take one half of  1mg of ativan. This is under my doctors care.  Check with your doctor and see what they can do for you would be my solid advice.  Keep on here, there is so much support, and we need all we can get.
God Bless / pm me if I can be of any help to you
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271792 tn?1334979657
Kim, were you also diagnosed by a doctor with having PAWS?
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Avatar universal
  Thanks for your comments, no i have not been diagnosed by a doctor. Paws is very common for long term sub use as it changes the brain chemistry. I have done a lot of research on the net, so i do not need a diagnosis from a doctor. Most doctors do not have much knowledge about paws. I feel your best to educate yourself. A few years ago i was given trazadone by a doctor, he said it was not addictive and i could stop when ever i wanted. I found out the hard way, and struggled for months to get off it. So now i take responsibilty for my own recovery.
    For me the first 3 months were worse. After 4 months the deep depression has gone and energy levels have started to come back., Im guessing it might be another couple of months for me.
    I see your on day 46 off lortabs, i would hope your paws will not last as long as mine as you were taking a short acting opiate. One thing i would be very carefull with is taking any drug, I know ativan is a benzo, You can get addicted to benzo's in a week or 2.
    The best treatment i have found for paws is to increase our endorphine levels naturaly, exercise, exercise, exercise, chocolate, chillies, sex.
     Oh you did not say how long you were on lortabs for? i think this can effect length of paws. If your paws is like mine, another 4 weeks and you should be over the worsed of it.
good luck
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1416133 tn?1351123217
IB asked a good question here.  I do believe only a Dr. can diagnose paws - and it typically doesn't happen (if at all) until after 6 months clean and up to two years after that so it would seem what you're probably experiencing is the of the residual effects of the withdrawal because some symptoms can linger on for a bit.  At least they did for me.
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Avatar universal
    Thanks for the comment, but all the research i have done states paws is very common with long term sub use. And it does not start after 6 months. It starts after the detox. You can find many studies stating this.(have a look on the net and this site). And i think you will find most doctors do not know much about paws. I cannot help but feel its not a good idea to put blind faith in what a doctor says. A lot of the information they get is from manufactures, hence they under - state the adverse effects some drugs can have, especialy after long term use.
   The lingering effects your talking about is paws, not withdrawal. caused by low levels of endorphines. (I took naltrexone, which knocks all opiates out of your system, so its not withdrawal after 4 months. Maybe its best agree to disagree on this.
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1416133 tn?1351123217
That's cool I can appreciate different points of view - and I have no experience with sub withdrawal so I'm not speaking from personal experience, only from the research I found on PAWS.  But it's cool - I'm okay with agreeing to disagree!  :)
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Avatar universal
Hiya. Am from the UK too. I've been on Subutex for 5 years now..

About LDN I've researched about it too. I know few people who did this route and all say after few days to a week on LDN you feel really crappy, low energy, depression etc, so it doesnt work for the long run, if anything it makes PAWS worst...Its no point doing it for 2-3 days, don't forget Sub hangs aroung a long time and something like LDN cannot suddenly kick start Endorphins which were reduced by Buprenorphine!..Someone in the U.S tried LDN for sub PAWS and only took it for the max 2 weeks (on & off), just to experiment, they claimed it helped for 1-2 days but then they became zombies..So then they went off the LDN and felt much better...They were on Buprenorphine-Suboxone for 5 years and their PAWS are gone too.

Best bet was to taper the sub, it can take literally 6-7 months to taper from 16mgs, hence of your depression 4 months out, those 4 months one can taper from 4mgs, you get the picture? if it takes that long to taper then obviously doing a quick detox as you did you will still feel some PAWS-depression 4 months out...Am on 1mgs now. Ive have no problems tapering from 8mgs...I will take another 2-3 months to go from 1mgs to 0 to give me the best chance possible to ride the withdrawals and PAWS...You should have tapered man. Also I excercise a lot and that makes a big difference to my tapering and mindset!

By the way what do they do in detox 5? what meds do they give?
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Avatar universal
   Thanks for your reply. Yes i think you might be right about ldn, only working for a short amount of time on subutex paws. Im guessing it increases endorphines at first, then seems to stop working. So i think you have helped me make up my mind, looks like i will have to ride this paws out naturaly. Bummer hehe.
   My mate did the long slow taper method like you, After about 5 years on subutex. And i think he did not suffer paws. If you get down to 0.25 i would stay there for a month or 2 just to make sure you do not get paws. Its a right pain, no motivation, low energy and depression, its not acute, its more the length of time it takes thats the really annoying thing. You feel like it will never end. I would of tapered if i could, but the subs stopped holding me and i was finding it hard to stay on 4mg. Are they still working and holding you?
   Not 100% sure of all the meds you get at detox 5,Trazadone, buscaban, naltrexone, sickness tablets, plus some injections. but they do work quite well, even when they give you naltrexone on the thursday. I did not even vomit or have diarra. I found it just got you over the acute withdrawal phaze. But there is still a lot of work to do when you get home.
Your brain still needs time to recover.
      Good luck with your final taper, i think thats the best root to take if you can do it. You will have to let me know how you get on. I hope you will be like my mate and miss out on the paws. Its the gift that keeps on giving hehe.
p.s Oh I would keep away from naltrexone, unless u are very scared of relapsing, At high doses it blocks your natural endorphines as well. I had a 3 month implant, i can still feel a small lump, so maybe im still getting a small dose, so maybe thats causing the depression.
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Avatar universal
What if I transfer to a short-acting-opiate once I reach 0,2mg of Subutex-Temgesic? just to hold out the half-life of sub.

Also I believed that u cannot do a rapid detox of buprenorphine, not in the UK anyway and even in the US for most folks it doesnt work because of the long half-life of Sub...They eventually say all the withdrawals and PAWS come back and u must do it a slow and needs time without inputting any meds, injections etc...u am curious how did they rid all that half-life of Sub from u, even though they gabe u naltrexone the sub has a very-long half-life, so add that together from all your previous doses it can takes weeks and months for that half-life to go out so am curious how they managed to do it in 5 days.
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Avatar universal
And about LDN. I heard the more u take it the less it raises Endorphins, for instance u take it for the first time it may raise ur endorphines for about few days, but if u take a second time in few days or weeks then it doesnt do the same job, meaning it doesnt always raise endorphines, I think thats true based on my Research and from people's experiences..Its no point raising endorphins for 1 day or 2 only to be extend the PAWS and LDN to stop-working.

How do u take the LDN? from on-line pharmacies right? because here in the UK they dont give u a LDN, only 50 tablet, so u must do-make it yourself right?
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Avatar universal
Your mistaken about not being able to do a rapid detox off subs, they give you naltrexone on the 4 day which strips all the subs out of your system. It has a stronger binding effect on your receptors than subs, so knocks all the subs off your receptors and blocks them with naltrexone.
But i think your right about ldn hehe, i have taken it again tonight, but will not be doing it again. Looks like i will just have to be patient.
I got a months supply from the detox centre so i just crush them up 50mg and split down to 2mg.
How are you finding your taper, i used to get big headaches when i tapered.
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Avatar universal
But then anything such as Lofexidine can cover you until the acute withdrawals of Subutex go away or Clonidine..The half-life is so stacked in the system that even when any sub in your system is out you still feel withdrawals, albeit mild but long, you dont need neltrexone for that, you only need 4-5 days to a week for sub to get out of your system, but it;s the half-life which contributes to PAWS which is the main issue..I know many sub users who dont mind so much the acute withdrawals but the PAWS which u have are the issue, I know it looks like a big waste of money going inpaitient-detox-5 to get off sub but one can take diazepam or anything else for a week to rid the subs out of the system. Because it's the receptors which sub fills and thus give PAWS! Many people dont vomit or get sick when going through Subute-Buprenorphine withdrawals but they get sick of the long-lasting withdrawals of it which your having, in that sense it seems bit of a waste doing detox-5 to get off sub. Remember stuff as such heroin have hardcore acute withdrawals, they are totally different to Subutex withdrawals..You could have just taken some meds until sub came out and you';d still be in the same boat...Also naltrexone tablers are dirty cheap for the net and u could have done it yourself..I  got tons of naltrexone tablets at home, all for the price for a mere £20....Also when taking neltrexone it it depletes your endorphins more, mix that with coming off opiates or sub it just gives you extra grief and depression...Like u said best method is taper slowly or use comfort meds to get subs out of your system instead of paying all that much money for detox-5..What folks suffer with is PAWS,many would rather have acute withdrawals then suffere paws for months and years...

MY taper is soo far soo good..I do lot of excercise and keep busy!
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Avatar universal
I mean about 50mg naltrexone, when they give it to you on the 4th day your already coming out of a deranged state & have some depression anyway, so mxing naltrexone on the 4th or 5th day just causes more depression and lowers the Endorphins, the Endorpins are already depleted during the 4th and/or 5thday so I dont really think it's worth it..I mean the subs can be knocked of the receptors but it's the half-life which cannot, hence of what contributes to PAWS..Also receptors have already been flooded because of the half-life and thus one gets PAWS..
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Avatar universal
Warning warning, never never never take a full dose of naltrexone when on subs and at home. You will want to kill yourself because of the pain. I know 2 guys did it together, both said they would of shot themselves if they had a gun.
You talk about depression because of the naltrexone on day 4, its not really an issuie, because of all the meds your on and your asleep most of the time.
And yes detox 5 only gets you past the acute detox phaze,  But if you do a natural acute withdrawal at home, no way will you start to feel better after 4 or 5 days. Its only just kicking in after day 4.
Im glad your tapers going well, i think thats the best method. good luck with it. Some days im  tempted go back on 0.2 0r 0.4mg, because of this bloody paws. Its not that bad for 1 day, but after 4.5 months it gets a little annoying hehe.
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Avatar universal
I contacted Detox-5 and they said if you wean down to the lowest amount possible and so it slow then there is no need to come in for detox..I think they only detox folks who stopped at a high dose or weaned down quickly in the space of a week or so..Is that true Waiting88? they said it's not really going to be worth getting detoxed over 0.2mg as most of the sub will have gotten out of your system, or whatever sub is in your system is only 0.2mg worth of withdrawal which is not worth paying £3,000 for as it won't be so intense..You tapered pretty fast didnt you and was on a high dose when you went into Detox-5 right?.


I didnt plan to use Naltrexone and I dont, well not at the moment, if I did it will always be a week or 2 after I jump...Am just concerned about it blocking Natural-Endorphins when your Endoprhins are already going to be depleted for weeks and months..Also I dont plan on using opiates to get high or relapse.. I haven't touced heroin in 5 years and haven't touched anything else either..I've totally changed that mindset a long time ago.. I only ever did heroin 4 years on and off, but it's just a shame I've been on Subutex this long..Hopefully my age, my pshycal-routine, mentally stable etc will get me past the withdrawals and PAWS..I also hav a very supportive family so that will keep me in good-stead!
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Avatar universal
Yes i went in at 12mg and 4mg. I think there right about its not worth doing at 0.2mg. Why jump off at 0.2mg? if your not struggling with your taper go to 0.1mg, 0.05mg ect then start skipping days. The lower you can get the less chance of getting paws. I jumped off at 4mg because the subs stopped holding me and i was getting side effects.
As i stated before my mate had a similar history to me,doing opiates. he did a long and slow taper and suffered no paws.
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Avatar universal
   I tried ldn at 2mg for 3 days, Increased my energy and mood, you could even say it made me a little high. Stopped and the depression came back on day 2. And it seemed to of made the paws worse for a few days. So i did another 3 day on ldn, by day 2 my mood and energy levels increased again, but not the high like the first time. Stopped for 3 days and im still in a good mood. Maybe on day 1 and 2 rls increased at night. So my plan is to see how long the depression stays away for. Then have another ldn dose.
    My theory being that im just trying to give my endorphines a small boost just enough to take the depression and low energy away. I do not want the 200%-300% increase a daily dose of ldn can give you. scared my opiate starved brain would get used to the high level of endorphines and go back into paws when daily ldn dosing is stopped.
   I have read many stories about ldn for paws, some people seem to do ok others not. So i will be interested how this experiment works.  Be nice to here from anyone doing ldn and  how it effected them.
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Avatar universal
The thing with LDN is that it doesnt do much for long-acting-opiate PAWS as compared to short-acting-opiates. Everyone who has come off sub and whome tried LDN all say it postpones PAWS back, for instance it will give u a rise of Endorphins for 2 days then stop working, it will stop working because it will push your PAWS back further, meaning extending them..The more you do LDN the more times u will have to take it as your only pushing PAWS back..The hypnosis of kick-starting Endoprhins proved to be wrong for long-term sub-meth users. The best form of raising endoprhins is to Excercise and ride it out. Also there aren't much stories of LDN for sub users except few in reality (outside of Internet) remember PAWS differ's to each person and sub PAWS are very different to PAWS from heroin and other short-acting-opiates...You just dont want to be relying on LDN all your life, because pshyclogically you will get depedent on that as you will need it to raise your Endorphins, so be careful in that regard..Also I heard it effects the liver more then alchohol believe it or not? my prescribing Doctor said this, so you just might want to think about this carefully a lot more..Anything which helps your mood usually has side-effects and one has to play the piper...Your just dont want to be making your PAWS worst of holding them back is all.
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Avatar universal
Also one more thing I may add importantly..This American person who did LDN for suboxone also said  the half-life of LDN can stay with you for a few days and even weeks, making the mistake of thinking your natural Endorphins rised, but thats not the case, it holds you until the LDN comes out of your system and then it's back to square one again i.e PAWS..So like I said be very careful and try to be strong-minded in going naturally, you dont want to be depedent on anything for the rest of your life, my doc said LDN is really for those folks who need Endorphin rush all their lives, surely u dont want your PAWS to be extending and extending by the LDN..Ok be well and try to ride it out I say!
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Avatar universal
Also do you take your LDN in the evenign or morning? apparently you cannot get a full nights sleep with LDN if taken at night..Also you do know that the more u take LDN the more reliable u have to be on it? and the worse depression gets..You might feel ok now but thats because of the Half-life of LDN, hope you do realize that, it builds up in your system, even if you take LDN every 3 days or 4 days your building it up, so dont make the mistake of thinking its your natural endorphins which have risen, but infact its the LDN, so that proves the theory that the more u take LDN the more u will have to rely on it and more u will need it,  if u stop it will take time to be back where u before LDN, basically making PAWS longer and worse...I know because 3 people said the exact same thing, all sub-users, so be careful.
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Avatar universal
  The experiment continues hehe, well this is day 4 or 5 without ldn and im still in quite a good mood. The depression is the worse part of paws, which has lifted for the time being. Still have rls for a couple of hours at night, but thats not a big issue. I take ldn at 10pm, i did not notice any changes in my sleep pattern. eg normaly i can not get to sleep untill about 2am because of rls. (only have slight rls at night when i want to sleep now).
   Not sure i agree with you about ldn half life and biulding up in your system, It works by only attaching to your receptors for 3 or 4 hours, (because your only taking a 2% normal dose), blocking endorphines, your body see's a decrease in endorphines so up-regulates. You will not feel this up-regulation untill the naltrexone has left your receptors.
     I know what your saying about possibly putting paws back, thats conerns me. There is also a theory that ldn helps re-confirm pathways in the brain that we have not used in a long time.
     Oh about effecting your liver, really think its not a problem when taking 2% of a normal dose.
       Cheers for your info, i understand what your saying about ldn making paws worse, i was hoping ldn would be a gentle way to ride out paws and help get some time between me and subs.
      So we will see what this weeks bring and if the depression comes back without the ldn.
      
  
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Avatar universal
Hows your taper going? are you finding easy?
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Hey man.. Yes I get what your saying, same thing was said about bup-sub about the half-l/ife being 37 hours yet people still experience foggyness-paws for weeks on end, its the same with LDN, it might leave your system for a few days but mentally its still there...Did u know sub PAWS can also be caused by the effects by sub? meaning something like brain lesions? tyroid? testorone? all this can be effectd by sub and can lead to PAWS or/and long PAWS, so try to get yourself checked out..Someone I know still has PAWS 2 years after jumping from bup, she was on it for 2 years, she said depression was worse, no motivation, numbness etc and she decided to go to the Doctors and guess what? she had an MRI scan which revealed 11 brain-lesions, all caused by the sub, if she never had these brain-lesions then she would have not had PAWS this long, so yeah get yourself checked out for anything, get blood-testes, liver test, brain test etc I know its not good news but thats one of the reasons why people have long PAWS, because sub triggers something in our bodies and mind...

There are no long-term studies on bup, it's still relatively new opiod, espeacially for maintence and nobody truly knows the long-term effects of bup if take for long-term. It does makes sense why some people have long PAWS though, another person also had brain-lesions after bup , so it's not always the sub alone whch gives u paws but what sub does to the mind and body which triggers sickness, illnesses etc which give long PAWS.

About the LDN and liver, my Doctor said even 0.5mg is effective as a bottle of vodka, someone did a liver test and they had ineffective liver enzymes because of LDN, thats what my doctor said so there is a possibility it effects parts of the body such as Liver..

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