Suboxone vs Norco detox

[Marina44]

Hi Doctor,

I had been going to a pain doctor for 2-3 years for a neck injury-I wasn't comfortable taking opiates anymore and wanted to get off.  He sent me to an addiction specialist-I had been taking Kadian 30 mg 2x a day, 8-10 Norco 10/325. I went off of the Kadian pretty easily-then started the suboxone, I was able to decrease pretty fast until 2 mg-I was on 2 mg for about 4 days and went off-I began having withdrawl so I went back on the Norco-I had severe withdrawls last night so today I took 4mg of Sub-I am going to go down to 2mg tommorrow and stay that way.  How long should I stay on two mg before I come off-I have read some people are on 1 mg-I don't know if I can shave the pill to 1 mg successfully.  Do you think I should go back on Norco and try to wean off of that instead? or con't with the Suboxone?  From what I have been reading the Suboxone is highly addictive...

[mulberrybern]

Why are you tapering off.  I would stay on the subs untill you have a few years clean.  The cravings for opiates are amazingly brutal.  It is nearly impossible for me to get over them thats why I am in on suboxone.  I would consider staying on for a while if it is financialy feasible.  Your going to go through some amount of withdrawl no matter what.  Thats just the way it is.  
thanks
cory

[Marina44]

Hello doc, I could not find in suboxonetalkzone about micrograms.  My doctor told me if I was down to two mg I did not need to be on it anymore.  So I went w/o it for 4 days then took 1mg and 2 days later 1 mg.  Can I continue doing it this way or will it prolong the process.  Or do you think I should just go back on Norco and taper down?

[J T Junig, MD PhD]

Suboxone contains buprenorphine, an opiate that is a partial agonist at the receptor and that has been around for over 30 years.  If you read any 'goodman and gilman' (the bible of pharmacology) you will read that 'buprenorphine is less addictive than other opiates because of the partial agonist effects'.  But for anyone addicted to opiates, even codeine is very addictive!  As I just wrote in another post, Suboxone is not used as much for 'getting off opiates' as it first was;  the paradigm has shifted as data has been collected, showing ('duh', for some of us who understand addiction!) that when people stop ANY opiate, they tend to resume using sooner rather than later-- unless the taper is just a prelude to residential treatment of at least 90 days followed by years of aftercare and a lifetime of meetings or similar recovery program.

Tapering off opiates is a 'fool's errand';  people usually do it over, and over, and over again...I've done it, I've seen it, and I've read about it, over and over again, patient after patient.  So I am not that concerned about 'weaning', as if you are like most people, you will eventually become an expert at it!  But it is very difficult to taper using Suboxone-- it is simply too potent to use in small doses.  Realize that a dose of 5-10 MICROGRAMS is potent for a person who is opiate-naive!  2 mg is 2000 micrograms-- a big dose.  If you go to my blog, suboxonetalkzone.com, and search under 'micrograms', you will get a couple ideas for tapering.  The reason everyone thinks Suboxone is so hard to taper is because they all 'jump' from 1000-2000 micrograms-- and the withdrawal is almost exactly the same from that level as it is from 16 mg!

There is a bit less 'pull' when tapering off buprenorphine;  people seem more  able to stay with the taper rather than resume a higher dose.  But the high potency almost makes it easier with an agonist, such as hydrocodone or oxycodone.