Long term soboxone abuser trying to quit ASAP! Cant make the final leap after long weaning process.

My fiance used soboxone to quit morphine 5yrs ago and now cannot function properly without snorting a least a small about of soboxone every day.  He no longer wants to live in a weekly struggle to find pills illegally and wants to quit ASAP!  He has been reducing the amount he has been taking over the last few months so he can make an 8mg pill last almost a week.  After only a day or so without snorting some he goes into horrible withdrawls (shaking, cant sleep, sweating, very ill, etc.) everytime he stops completely.  I heard that clonidine can help reduce the worst affects of withdrawls but was unsure about possible addiction to that or side effects.  I head that low blood pressure could be a major isse since clonidine is primarily a blood pressure medication.  The last thing he wants is another cycle of replacing an addiction with a new addiction.  His health insurance is through his job and he is worried if he goes to a doctor and says he has an addiction to soboxone and needs help getting through withdrawls by taking clonidine his job may find out and terminate him.  He is on call 24hrs a day 7 days a week in case of emergencies at work but can use vacation time to get through the worst of his symptoms if neccesary.  So I guess here are my main questions:

1. Is the clonidine worth trying so he can get off the soboxone?

2. Can the clonidine be prescribed by a regular physician's visit?  If so, what should be said to facilitate the process?

3. What are the dangers posed by this tactic?

4. Will his use of his job's insurance company mean that they will find out about the soboxone use?

Any help would be great as we would like to figure out a game plan we can set into motion safely and swiftly.

[J T Junig, MD PhD]

I have 100 patients on Suboxone-- 97% are currently employed.  They are factory workers, welders, lawyers, policemen, nurses, secretaries, and even long-haul truck drivers.  Many are urine-tested for their job, and none have ever had a problem from being on Suboxone- so I cannot imagine what you are talking about when you say someone will be 'immediately terminated' for being prescribed a medication for a potentially-fatal illness.

It does not matter what you use to taper off Suboxone;  from the sound of things, the person will only be back in the cycle of using again, only to repeat the process.  The relapse rate for opioid dependence is very high-- and the condition must be treated for life.  Simply tapering off buprenorphine is not a 'sobriety plan'.

Comparing the use of buprenorphine to the addiction to pain pills shows a lack of understanding for the difference between 'addiction' and 'physical dependence.'  During active addiction to opioids, the addict is obsessed with using-- and that obsession destroys all other aspects of the person's life.  Being on a 'ceiling level' of Suboxone relieves the obsession to use, and places addicition into remission.  A person snorting small pieces of a Suboxone tablet is NOT at that ceiling level, and is not getting the benefit of Suboxone--  he might as well be snorting oxycodone.  

I recommend that he find an addiction doc who can treat him properly, and advocate for his job if necessary.  It is a fool's errand to taper off one opioid after another, each time thinking that THIS time will be different.  I know-- I've been there!

[answersplease44]

I am aware of the addictive personality having been sober from alcohol myself for over 5yrs.  He has the desire to quit, works over 50 hours a week and runs every other day.  But it is the withdrawl (withdrawal) symptoms I am concerned about controlling.  Will they be lessened even more by reducing his 1mg a day habit down such a small amount to 2mg every 3 days (or 0.67mg a day).  They are unbareble to witness and make work impossible for him.  Why do you believe "It is easy" to quit after years of abuse?  A doctors prescription to suboxone is out of the question due to an immediate termination of a job held succesfully for many years.